title: A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia.
abstract: BACKGROUND
  Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial.
  
  
  METHODS
  Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7-10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status.
  
  
  RESULTS
  No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post-dural puncture headache, hemodynamic stability, or obstetric outcomes.
  
  
  CONCLUSIONS
  Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. valerie.arkoosh@gmail.com
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Arkoosh
authors.forename: Craig M
authors.initials: CM
authors.lastname: Palmer
authors.forename: Esther M
authors.initials: EM
authors.lastname: Yun
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sharma
authors.forename: James N
authors.initials: JN
authors.lastname: Bates
authors.forename: Richard N
authors.initials: RN
authors.lastname: Wissler
authors.forename: Jodie L
authors.initials: JL
authors.lastname: Buxbaum
authors.forename: Wallace M
authors.initials: WM
authors.lastname: Nogami
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gracely
mesh_terms: D016362:Analgesia, Obstetrical / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000767:Anesthesia, Epidural / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D036861:Delivery, Obstetric; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects; D011247:Pregnancy; D012107:Research Design; D012449:Safety; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D017409:Sufentanil; D002045:Bupivacaine