Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 ug.mL-l: a study in singleton breech presentation

ABSTRACT

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In the present trial, continuous epidural infusion of bupivacaine 0.125% was compared with a combination of a low concentration of bupivacaine [0.0625%] and sufentanil [0.25 ug.mL[-1]]. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between bupivacaine group [n =23] and bupivacaine-sufentanil group [n =35]. A greater number of patients in the bupivacaine 0.125% group required more than two top-ups [32% vs. 8%, P =0.03] while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a non-significant decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group [92% vs. 74%, P = 0.09]. Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was a non-significant difference in mode of delivery between the two analgesic regimens