Bupivacaine augments intrathecal fentanyl for labor analgesia

Craig M. Palmer, Gretchen Van Maren, Wallace M Nogami, R. N. Diane Alves

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Intrathecal fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low- dose bupivacaine added to intrathecal fentanyl for labor analgesia. Methods: Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 μg; bupivacaine, 1.25 mg, with fentanyl, 25 μg; or bupivacaine, 2.5 mg, with fentanyl, 25 μg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded. Results: Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 μg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged. Conclusions: The addition of 2.5 mg isobaric bupivacaine to 25 μg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with. plain intrathecal fentanyl.

Original languageEnglish (US)
Pages (from-to)84-89
Number of pages6
JournalAnesthesiology
Volume91
Issue number1
DOIs
StatePublished - Jul 1999
Externally publishedYes

Fingerprint

Bupivacaine
Fentanyl
Analgesia
Injections
Fetal Heart Rate
Muscle Strength
Analgesics
Anesthetics
Mothers
Blood Pressure
Spinal Injections
Pruritus
Lower Extremity
Parturition
Pain

Keywords

  • Opioids
  • Pain
  • Parturition
  • Spinal
  • Subarachnoid

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Bupivacaine augments intrathecal fentanyl for labor analgesia. / Palmer, Craig M.; Van Maren, Gretchen; Nogami, Wallace M; Diane Alves, R. N.

In: Anesthesiology, Vol. 91, No. 1, 07.1999, p. 84-89.

Research output: Contribution to journalArticle

Palmer, Craig M. ; Van Maren, Gretchen ; Nogami, Wallace M ; Diane Alves, R. N. / Bupivacaine augments intrathecal fentanyl for labor analgesia. In: Anesthesiology. 1999 ; Vol. 91, No. 1. pp. 84-89.
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abstract = "Background: Intrathecal fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low- dose bupivacaine added to intrathecal fentanyl for labor analgesia. Methods: Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 μg; bupivacaine, 1.25 mg, with fentanyl, 25 μg; or bupivacaine, 2.5 mg, with fentanyl, 25 μg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded. Results: Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 μg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged. Conclusions: The addition of 2.5 mg isobaric bupivacaine to 25 μg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with. plain intrathecal fentanyl.",
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