Duration Of Labor Analgesia Research Articles

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Walking epidural in labor analgesia: A comparative study of ropivacaine with fentanyl and without fentanyl

Background: Labor pain and child birth entail a number of physiological consequences that may lead to deleterious effects on the mother and fetus. Implication of a neuraxial technique is being appreciated in labor. Fetal prognosis and maternal consent and its satisfaction are key to labor analgesia. Method: The primary objectives were to determine the visual analog scale (VAS), total duration of labor analgesia, patient-controlled analgesia demand, sensory and motor block, and hemodynamics. The secondary objectives were to determine obstetrics parameters such as maternal satisfaction, cervical dilation, membrane, APGAR score, and complications such as hypotension, bradycardia, and vomiting. A randomized prospective comparative, interventional study including 50 parturients was conducted, where they were divided into two equal groups of 25 each, and epidural analgesia was given by 0.2% ropivacaine with 2 mcg/ml fentanyl and 0.2% ropivacaine without fentanyl. Observation and Results: Analgesia was more in the RF group compared to the R group. The maternal satisfaction was more in the RF group than in the R group. Clinical hemodyamics, VAS score, Bromage score, and APGAR score were appreciable in the RF group as compared to the R group. Conclusion: We concluded that 0.2% ropivacine with fentanyl gives more analgesia and maternal satisfaction than ropivacine alone.

Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section

Objective To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion. Methods Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women’s and Children’s Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered. Results A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037–1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031–1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23–1.93; p < .01). Conclusion Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGES Prolonged duration of epidural labour analgesia > 8 h is associated with conversion failure. If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications.

Effects of Dural Puncture Epidural Technique on Onset and Duration of Labor Analgesia

Abstract Background: In the dural puncture epidural technique (DPE), a dural hole is intentionally created, but no intrathecal drugs are administered. Our study's main objective was to compare the onset and duration of DPE analgesia with a conventional epidural (CE) when an intermittent epidural bolus dose was used. Materials and Methods: The double-blinded randomized control study was conducted on 60 parturient in active labor. Patients were randomly assigned into two groups using a computer-generated random sequence by closed envelope technique. Group CE received conventional labor epidural with 20 mL 0.1% ropivacaine and 30 μg fentanyl. In group DPE, dural puncture was performed, and 20 mL 0.1% ropivacaine and 30 μg fentanyl were given through an epidural catheter. The onset of analgesia, number of bolus doses required, and pain scores were monitored. Results: The onset of analgesia was faster in Group DPE than CE (4.40 ± 1.32 vs. 6.37 ± 2.04 min, P &lt; 0.001). There was no significant difference in analgesia duration between the two groups (109.00 ± 26.63 vs. 104.17 ± 30.62 min, P = 0.517). The requirement of top-up doses was similar in both groups (2.47 ± 0.50 vs. 2.50 ± 0.50, P = 0.80). At 5 min, mean visual analog scores were less in DPE than CE group, and this difference was statistically significant (2.43 ± 1.25 vs. 3.97 ± 1.84, P = 0.002). Conclusion: Both techniques were effective in producing labor analgesia. However, the use of DPE technique with a 27G spinal needle produced faster onset of analgesia than CE technique when intermittent epidural boluses were used without affecting the maternal and fetal outcome.

Effect of Epidural Bupivacaine Versus Intrathecal Single Dose inAnalgesia during Normal Vaginal Labor of Multiparous Women

AbstractBackground: Epidural analgesic technique is the mostcommonly used and most effective analgesia during labor.Intrathecal labor analgesia is alternatively and effective methodto provide labor analgesia.Aim of Study: To compare the effect of epidural bupi-vacaine versus single-dose intrathecal bupivacaine duringlabor of multiparous women on the duration of labor analgesia,progress of labor, block characteristics and side effects.Material and Methods: In a prospective randomizeddouble-blind study, 80 multiparous women of ASA class Iand II were randomly allocated into two groups of pregnantwomen 40 each. The spinal group received hyperbaric bupi-vacaine 0.5% at a dose of 3.75mg (0.75ml) of hyperbaricbupivacaine with 25ug fentanyl (0.5ml) and diluted withsterilized normal saline to 1.5ml whereas the epidural groupreceived isobaric bupivacaine 8-10ml of 0.125% bupivacainewith fentanyl 50mg. Patients were monitored for hemodynam-ics, sensory and motor block characteristics, side effects,duration of stages of labor and pain intensity was also recorded on a visual analogue scale.Results: Maternal hemodynamics showed a nonsignificantchanges between both groups. Onset of sensory block andduration were significantly delayed in epidural group incomparison to spinal group (8.80±5.27, 163±16.64min) vs (4.6± 1.20, 120.2±3.33min) and visual analogue scale comparable in both groups but scale was lower in the spinal group. Patient's satisfaction was insignificantly more in S group. The duration of the first and second stages of labor in the spinal group was shorter than that in the epidural group and incidence of maternal complications in both groups were insignificant.Conclusion: A safe and effective alternative method toepidural analgesia is a single-dose intrathecal bupivacaine.

Effect of auricular magnetic bead pressing on maternal body temperature, inflammatory response and placental pathological results in labor analgesia

To observe the effects of auricular magnetic bead pressing on maternal body temperature, inflammatory response and placental pathological results in epidural labor analgesia. 180 parturient who volunteered for labor analgesia were randomly divided into epidural group (n=90, epidural labor analgesia) and auricular pressing group (n=90, epidural labor analgesia combined auricular pressing). The tympanic temperature before labor analgesia (T1), 2 h (T2), 4 h (T3) and 4 h after labor analgesia (T4) were recorded. The total duration of labor, duration of labor analgesia, PCEA compression times, labor analgesia dose, cesarean section rate was counted, and the changes in serum IL-6 level and placental pathologyresults of the two groups were analyzed. There was no significant difference in age, BMI, gestational age, duration of labor, duration of analgesia and rate of cesarean section between groups(P>0.05). Times of PCEA compressions and labor analgesic dose in auricular group were lower than that in epidural group (P<0.05). There was no difference in tympanic temperature between two groups at T1 (P>0.05), and the tympanic temperature at T3 and T4 was higher than that at T1 (P<0.05). The tympanic temperature in T3 and T4, and incidence of intrapartum fever in the auricular group was lower than that in the epidural group (P<0.05).There was no difference in the prenatal serum IL-6 level between groups (P>0.05), and the postpartum serum IL-6 level was higher than that before labor in either group (P<0.05).The postpartum serum IL-6 level and the incidence of HCA in the auricular point group were lower than those in epidural group (P<0.05). Magnetic beads auricular pressing therapy has advantages in reducing intrapartum fever by modulating maternal inflammation and reducing the dosage of local anesthetics effectively during epidural labor analgesia.

Rates of Fentanyl Positivity in Neonatal Urine Following Maternal Analgesia During Labor and Delivery.

Fentanyl is commonly given as an analgesic during labor and delivery. The extent of transplacental drug transfer and fetal exposure is not well studied. We analyzed the relationship between neonatal urine fentanyl results and various peripartum factors. A total of 96 neonates with urine toxicology screening between January 2017 and September 2018 were included in the study. Medical record review was used to obtain maternal, neonatal, and anesthesia parameters. A subset of 9 specimens were further tested for levels of fentanyl and norfentanyl by liquid chromatography-tandem mass spectrometry. In 29% (n = 24) of cases associated with fentanyl-containing labor analgesia, neonatal toxicology screens were positive for the presence of fentanyl. Positive test results strongly correlated with the cumulative dose and duration of labor analgesia (P < 0.001). The odds of positive neonatal fentanyl screen results increased 4-fold for every 5 hours of maternal exposure to labor analgesia. Importantly, however, neonatal outcomes for infants with positive and negative urine fentanyl screens were the same. Our study establishes that maternal fentanyl analgesia is strongly associated with positive neonatal urine fentanyl screens and suggests that more judicious use of these laboratory tests may be warranted.

Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial

(Anesthesiology. 2018;128:745–753) Neuraxial labor analgesia is usually administered by a combination of continuous infusion, clinician-administered boluses, and patient-administered boluses via patient-controlled epidural analgesia (PCEA). While the ideal labor analgesia regimen has yet to be determined, studies suggest programmed intermittent epidural boluses (PIEB) may be a superior option. PIEB has been shown to require less local anesthetic, reduce need for clinician intervention, and results in less motor block compared with a continuous infusion. High-rate delivery of epidural boluses may improve drug distribution when compared with low-rate administration as it increases delivery pressure at the catheter tip. The authors hypothesized that compared with women maintained using a low-rate PIEB and PCEA regimen, a high rate PIEB and PCEA regimen would result in less breakthrough pain, reduced PCEA request-to-delivery ratios, decreased bupivacaine consumption, and fewer provider-administered supplemental boluses.

A comparative clinical study of intrathecal bupivacaine 2.5 mg with dexmedetomidine 5 μg versus intrathecal bupivacaine 2.5 mg with fentanyl 25 μg on the duration of labor analgesia using combined spinal epidural technique

Context: Adjuvants may be added to decrease motor blockade caused by intrathecal bupivacaine and prolong labor analgesia. Aim: To study the effect of intrathecal dexmedetomidine versus fentanyl when added to bupivacaine on the duration of labor analgesia, progress of labor, block characteristics, and side effects. Settings and Design: A prospective, randomized double-blind study. Materials and Methods: Sixty parturients consenting for labor analgesia were divided into two groups. Group A (n = 30) received an intrathecal 0.5% hyperbaric bupivacaine 2.5 mg and dexmedetomidine 5 μg and Group B (n = 30) received an intrathecal 0.5% hyperbaric bupivacaine 2.5 mg and fentanyl 25 μg. Partogram, visual analog score, sensory and motor blockage, progress of labor, maternal hemodynamic variations, and fetal heart rate were noted. Statistical Analysis Used: Standard qualitative and quantitative tests were used to compare data (e.g., unpaired student t-test, ANOVA, Chi-square); P value of 0.05 was considered significant. Results: Duration of labor analgesia was significantly greater in Group A as compared to Group B (254.17 ± 4.75 min vs. 123.67 ± 6.01 min, P 0.05).

Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial.

Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial. Neuraxial analgesia was initiated with intrathecal fentanyl 25 μg. The maintenance epidural solution was bupivacaine 0.625 mg/ml with fentanyl 1.95 μg/ml. Programmed (every 60 min) intermittent boluses (10 ml) and patient controlled bolus (5 ml bolus, lockout interval: 10 min) were administered at a rate of 100 ml/h (low-rate) or 300 ml/h (high-rate). The primary outcome was percentage of patients requiring provider-administered supplemental bolus analgesia. One hundred eight women were randomized to the low- and 102 to the high-rate group. Provider-administered supplemental bolus doses were requested by 44 of 108 (40.7%) in the low- and 37 of 102 (36.3%) in the high-rate group (difference -4.4%; 95% CI of the difference, -18.5 to 9.1%; P = 0.67). Patient requested/delivered epidural bolus ratio and the hourly bupivacaine consumption were not different between groups. No subject had an adverse event. Labor analgesia quality, assessed by need for provider- and patient-administered supplemental analgesia and hourly bupivacaine consumption was not improved by high-rate epidural bolus administration.

Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

Background: Dural puncture epidural (DPE) is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique. Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural). In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE) spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2%) with 20 mcg of Fentanyl (2 mcg/ml) in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS), sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome. Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05). Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

ABSTRACT Introduction Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade. Materials and methods This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test. Results A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups. Conclusion Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination. How to cite this article Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

Comparative Efficacy of Minimal Concentration of Racemic Bupivacaine (0.0625%) with Fentanyl and Ropivacaine (0.1%) with Fentanyl for Epidural Labor Analgesia.

Background and Aims:This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia.Settings and Design:The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing.Methodology:Sixty parturients requesting for labor analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R (n = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed.Statistical Analysis:Data were analyzed with odds variance, unpaired t-test, and Chi-square tests. P < 0.05 was considered statistically significant.Results:In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups.Conclusions:In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl.

Comparison of Different Bupivacaine and Fentanyl Combinations When Used with A Single Shut Spinal Block for Labor Analgesia

Background: Single-shot spinal analgesia with bupivacaine plus a short-acting opioid is an effective technique for pain control in labor, and it is particularly useful in the active phase. We compared the effects of adding two different doses of fentanyl (15 μg or 25 μg) to intrathecal bupivacaine, and to evaluate the impacts on duration of labor analgesia, newborn, and side effects. Method: One hundred and five multiparous healty women in advanced labor (cervical dilatation ≥ 7 cm, and pain score >5), requesting labor analgesia were included in the study. They were randomly allocated into three groups. Group I received 2.5 mg bupivacaine; Group II received 2.5 mg bupivacaine plus 15 μg fentanyl; Group III received 2.5 bupivacaine plus 25 μg fentanyl intrathecally. The patients' demo figure characteristics, hemodynamic parameters, pain scores (by using visual analogue scale - VAS), analgesic requirements, duration of analgesia (the time from intrathecal injection to the return of pain >4), fetal Apgar scores (at 1st and 5th min), and maternal and neonatal side effects were recorded. We used analysis of variance (ANOVA), post hoc test with Bonferroni adjustment, and chi-square test for statistical analysis; the analyses were performed using the SPSS-16 software. Given a significant level of 0.05, overall and pair-wise comparisons were made. Results: The mean VAS scores were significantly lower in Group II than in the other two groups at 5, 15, 30 min, and 1 h (P<0.001). There was no difference among Group I and Group III. The VAS scores were significantly higher in the Group III than in the other two groups at 2 (P=0.005) and 3 h (P<0.001). The incidence of adverse events was similar in all three groups. There was no difference in Apgar scores at 1 min, but Apgar score at 5 min was higher in Group 2 (P=0.02). Conclusion: In this study, we found that 2.5 mg of bupivacaine plus 15 μg fentanyl is more preferable option for SSA.

Large Heterogeneity in Mean Durations of Labor Analgesia Among Hospitals Reporting to the American Society of Anesthesiologistsʼ Anesthesia Quality Institute

(Abstracted from Anesth Analg, 121:1283–1289, 2015) The expected duration of labor analgesia for vaginal deliveries is influenced by several factors, from patients being homozygous for the adrenoceptor Arg/Arg16, maternal obesity, and fetal weight to obstetrical practices at various hospitals. This study sought to ascertain whether there are large differences in mean durations of labor analgesia during vaginal delivery in the United States and how those differences might affect fee-for-service groups as well.

Large Heterogeneity in Mean Durations of Labor Analgesia Among Hospitals Reporting to the American Society of Anesthesiologists’ Anesthesia Quality Institute

(Anesth Analg. 2015;121(5):1283–1289) Expected duration of labor varies widely and depends on multiple covariates, ranging from biological factors, such as genotype, obesity and fetal weight, to obstetrical practices, such as intention to reduce infection risk or provide a more natural birth. Such variability in mean duration of labor analgesia for vaginal delivery may influence appropriate equitable fee-for-service payments. In order to address this issue, the authors of the present study determined mean durations of labor analgesia among hospitals in the United States.

Intrathecal isobaric ropivacaine-fentanyl versus intrathecal isobaric bupivacaine-fentanyl for labor analgesia: A controlled comparative double-blinded study

Context: Neuraxial analgesia and walking epidural is the popular method of practicing labor analgesia. The combination of local anesthetic and opioid is advantageous as it prolongs the duration of labor analgesia. Ropivacaine is the newer local anesthetic agent having lesser motor effects and toxic effects hence would be preferred for labor analgesia. Aims: The primary objective of the study was to assess the duration of analgesia of the intrathecal drug. The secondary objective was the assessment of onset, fixation of analgesia, motor weakness, ambulation, sedation, incidence of side-effects, maternal, and neonatal outcomes. Settings and Design: This is prospective, randomized, controlled, double-blinded, study of 120 patients consenting for labor analgesia. Subjects and Methods: A total of 120 primiparas with a singleton pregnancy in active labor who were given combined spinal epidural (CSE) were included in the study. These patients were randomly allocated to three groups of 40 each and received CSE. Group F-received 25 μcg fentanyl intrathecally. Group BF-received 25 μcg fentanyl with 2.5 mg isobaric bupivacaine intrathecally. Group RF-received 25 μcg fentanyl with 2.5 mg isobaric ropivacaine intrathecally. Statistical Analysis Used: Correlations among different measurements were assessed using Pearson's correlation coefficients, P <0.05 was considered to be statistically significant. Results: The three groups show comparable demographic data and obstetric parameters. The duration of spinal analgesia was significantly greater with Group RF 106.63 ± 17.99 min and Group BF 111.75 ± 23.58 min than the control Group F which was 60 ± 10.39 min with P = 0.001, but were comparable for Group BF and RF. The secondary outcome was comparable in all the three groups. Conclusions: The addition of bupivacaine or ropivacaine to fentanyl intrathecally increased duration and quality of analgesia, did not affect ambulation and bearing down. The incidence of side-effects, maternal and neonatal outcomes and maternal satisfaction were comparable in all groups. Hence, the effect of both the local anesthetics with fentanyl intrathecally has similar effects, and there was no added advantage of ropivacaine over bupivacaine.

Comparision of efficacy of sufentanil and fentanyl with low-concentration bupivacaine for combined spinal epidural labour analgesia

Objectives:The highly lipid-soluble opioids, sufentanil and fentanyl, are used in combination with low-concentration bupivacaine to provide combined spinal epidural (CSE) analgesia during labour. We designed a prospective, randomized, single-blind study to compare the efficacy of these two opioids with bupivacaine in terms of the quality of analgesia, side-effects and maternal and foetal outcome.Methods:Sixty parturients requesting labour analgesia were divided into two groups randomly. Group S (n=30) received bupivacaine heavy (2.5 mg) and sufentanil (5 mcg) intrathecally and 10 mL intermittent bolus of sufentanil 0.30 mcg/mL in bupivacaine 0.125% as epidural top-ups. Group F (n=30) received bupivacaine heavy (2.5 mg) and fentanyl (25 mcg) intrathecally and 10 mL intermittent bolus of fentanyl 2.5 mcg/mL in bupivacaine 0.125% as epidural top-ups. Duration of intrathecal and epidural analgesia, mean duration between epidural top-ups and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with a 10-point visual scale. Mode of delivery and neonatal Apgar scores were recorded.Results:Maternal demographic characteristics were comparable between the groups. Although CSE provided satisfactory analgesia in both the groups, parturients of group S had a significant prolongation of analgesia through the intrathecal route compared with parturients of group F. Incidence of caesarean, instrumental delivery did not differ between the groups. No difference in the incidence of motor blockade or cephalad extent of sensory analgesia was observed. Neonatal outcome and incidence of side-effects were similar in both the groups.Conclusion:We conclude that combined spinal epidural using sufentanil and fentanyl achieved high patient satisfaction and excellent labour analgesia without serious maternal or neonatal side-effects. Sufentanil provided a significantly longer duration of labour analgesia compared with fentanyl.

Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion for Labor Analgesia

Programmed intermittent epidural anesthetic bolus (PIEB) technique may result in reduced total local anesthetic consumption, fewer manual boluses, and greater patient satisfaction compared with continuous epidural infusion (CEI). In this randomized, double-blind study, we compared the incidence of motor block and labor outcome in women who received PIEB or CEI for maintenance of labor analgesia. The primary outcome variable was maternal motor function and the secondary outcome was mode of delivery. Nulliparous, term women with spontaneous labor and cervical dilation <4 cm were eligible to participate in the study. Epidural analgesia was initiated and maintained with a solution of levobupivacaine 0.0625% with sufentanil 0.5 μg/mL. After an initial epidural loading dose of 20 mL, patients were randomly assigned to receive PIEB (10 mL every hour beginning 60 minutes after the initial dose) or CEI (10 mL/h, beginning immediately after the initial dose) for the maintenance of analgesia. Patient-controlled epidural analgesia (PCEA) using a second infusion pump with levobupivacaine 0.125% was used to treat breakthrough pain. The degree of motor block was assessed in both lower extremities using the modified Bromage score at regular intervals throughout labor; the end point was any motor block in either limb. We also evaluated PCEA bolus doses and total analgesic solution consumption. We studied 145 subjects (PIEB = 75; CEI = 70). Motor block was reported in 37% in the CEI group and in 2.7% in the PIEB group (P < 0.001; odds ratio = 21.2; 95% CI: 4.9-129.3); it occurred earlier (P = 0.008) (hazard ratio = 7.8; 95% CI: 1.9-30.8; P = 0.003) and was more frequent at full cervical dilation in the CEI group (P < 0.001). The incidence of instrumental delivery was 20% for the CEI group and 7% for the PIEB group (P = 0.03). Total levobupivacaine consumption, number of patients requiring additional PCEA boluses, and mean number of PCEA boluses per patient were lower in the PIEB group (P < 0.001). No differences in pain scores and duration of labor analgesia were observed. Maintenance of epidural analgesia with PIEB compared with CEI resulted in a lower incidence of maternal motor block and instrumental vaginal delivery.

Blood Pressure, but Not Cerebrospinal Fluid Fentanyl Concentration, Predicts Duration of Labor Analgesia From Spinal Fentanyl

Blood Pressure, but Not Cerebrospinal Fluid Fentanyl Concentration, Predicts Duration of Labor Analgesia From Spinal Fentanyl