A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia

Valerie A. Arkoosh, Craig M. Palmer, Esther M. Yun, Shiv K. Sharma, James N. Bates, Richard N. Wissler, Jodie L. Buxbaum, Wallace M Nogami, Edward J. Gracely

Research output: Contribution to journalArticle

47 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)286-298
Number of pages13
JournalAnesthesiology
Volume108
Issue number2
DOIs
StatePublished - Feb 2008

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Epidural Analgesia
Analgesia
Catheters
Safety
Nervous System
Sufentanil
Bupivacaine
Mothers
Postpartum Period
Post-Dural Puncture Headache
Nervous System Trauma
Anesthesia and Analgesia
Pain
Incidence
Neurologic Examination
United States Food and Drug Administration
Pruritus
Telephone
Obstetrics
Multicenter Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia. / Arkoosh, Valerie A.; Palmer, Craig M.; Yun, Esther M.; Sharma, Shiv K.; Bates, James N.; Wissler, Richard N.; Buxbaum, Jodie L.; Nogami, Wallace M; Gracely, Edward J.

In: Anesthesiology, Vol. 108, No. 2, 02.2008, p. 286-298.

Research output: Contribution to journalArticle

Arkoosh, Valerie A. ; Palmer, Craig M. ; Yun, Esther M. ; Sharma, Shiv K. ; Bates, James N. ; Wissler, Richard N. ; Buxbaum, Jodie L. ; Nogami, Wallace M ; Gracely, Edward J. / A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia. In: Anesthesiology. 2008 ; Vol. 108, No. 2. pp. 286-298.
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AU - Arkoosh, Valerie A.

AU - Palmer, Craig M.

AU - Yun, Esther M.

AU - Sharma, Shiv K.

AU - Bates, James N.

AU - Wissler, Richard N.

AU - Buxbaum, Jodie L.

AU - Nogami, Wallace M

AU - Gracely, Edward J.

PY - 2008/2

Y1 - 2008/2

N2 - 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.

AB - 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.

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