title: Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis.
abstract: This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI-FEN) and sufentanil (BUPI-SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta-analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I(2) index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI-SUF and BUPI-FEN administered mothers (mean difference [95%CI] of -33.55 [-74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of -0.61 [-1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score < 7 was significantly lower in BUPI-FEN group (odd ratio [95%CI] of 0.31 [0.10, 0.95]; P < .05). Pruritus incidence was similar. In conclusion, BUPI-FEN combination exhibits significantly better tolerability at an approximate ratio of 6 FEN:1 SUF, albeit, both fentanyl and sufentanil in combination with bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.
authors.affiliation: Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Huixia
authors.initials: H
authors.lastname: Wang
authors.forename: Chengjie
authors.initials: C
authors.lastname: Gao
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001034:Apgar Score; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D004338:Drug Combinations; D017409:Sufentanil; D005283:Fentanyl; D002045:Bupivacaine
keywords: analgesia; bupivacaine; epidural; fentanyl; intrathecal; labor; sufentanil