ABSTRACT
We studied 133 women given a combined spinal-epidural for analgesia in labour. The initial intrathecal dose contained bupivacaine 2.5 mg with fentanyl 25 micrograms. When the mothers were comfortable, they were allocated randomly to one of three groups: continuous infusion (group Cl, n = 46), midwife top-ups (group MW, n = 43) or patient-controlled epidural analgesia (group PCEA, n = 44), to maintain analgesia throughout labour. All epidural solutions contained 0.1% bupivacaine and fentanyl 2 micrograms ml-1. Motor block was assessed by the mother's ability to straight leg raise (SLR). Four hours after combined spinal-epidural analgesia, 88.1% of women could SLR in group MW, 83.7% in group PCEA and 57.8% in group Cl (P = 0.002). Total use of bupivacaine was highest in group Cl (mean 11.3 (SD 3.3) mg h-1) compared with group MW (7.5 (3.1) mg h-1) and group PCEA (9.1 (2.1) mg h-1) (P < 0.001). Analgesia was similar between groups and overall satisfaction was equally high.
Subject(s)
Ambulatory Care/methods , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Analgesia, Patient-Controlled , Locomotion , Adolescent , Adult , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Female , Fentanyl/administration & dosage , Humans , Infusions, Parenteral , Injections, Spinal , Midwifery , PregnancyABSTRACT
Bupivacaine 15 mg is commonly used as a test dose prior to the initial dose for epidural analgesia in labour. When 15 mg or 25 mg of bupivacaine (15 ml of 0.1% or 0.167%) with 50 microg fentanyl was administered blindly to two groups of labouring women, as an initial dose, 83% and 90% of women respectively, achieved analgesia within 20 min. All the remaining women achieved analgesia with a further dose of 10 mg bupivacaine (10 m10.1%) with fentanyl 2 microg per ml given at 20 min.
