Combined spinal-epidural analgesia and epidural analgesia in labor: effect of intrathecal fentanyl vs. epidural bupivacaine as a bolus.
OBJECTIVE
To compare the clinical effects of intrathecal fentanyl with conventional epidural bupivacaine bolus before the same continuous epidural infusion for labor analgesia.


METHODS
Fifty parturients in active labor were randomized to receive subarachnoid fentanyl 25 mcg as part of a combined spinal epidural analgesia (CSE) or bupivacaine 0.25% 10 ml incrementally into the epidural space in the epidural group. After that, 0.0625% bupivacaine with fentanyl 2 mcg/ml was infused via epidural catheter in all women at a rate of 12 ml/h. Verbal numeric pain scores (VNPS), onset time to pain relief times of additional analgesia and other side effects were recorded.


RESULTS
Mean (SD) onset time to the first pain free contraction was not significantly different (7.8 +/- 4.3 min in the CSE group, 10.2 +/- 5.1 min in epidural group, p = 0.085). Most of the patients in the CSE group required additional epidural bolus dose (80% compared to 48% in the Epidural group, p = 0.038). There was no difference in motor blockage at time of delivery or mode of delivery. Significantly more women in the CSE group had pruritus (68% VS none in the epidural group, p < 0.001), all had mild degree and did not require any treatment. There was no difference in other side effects.


CONCLUSIONS
Intrathecalfentanyl as part of CSE did not produce statistically a significant faster onset compared to epidural bupivacaine bolus. Most of the patients in the CSE group required epidural bolus after intrathecal fentanyl with a higher incidence of pruritus.
Ngamprasertwong
Pornswan
P
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Kumwilaisakmd
Kanya
K
Indrambarya
Toonchai
T
Supbornsug
Kaew
K
Ngarmukos
Suchera
S
D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D011247:Pregnancy
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine