| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Canadian Journal of Anesthesia, Vol 43, 341-346, Copyright © 1996 by Canadian Anesthesiologists' Society
ARTICLES |
S Cohen, D Amar, CB Pantuck, EJ Pantuck, EJ Goodman and DH Leung
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA.
PURPOSE: The highly lipid soluble opioids, fentanyl and sufentanil, are used in combination with local anaesthetics with/without epinephrine to provide epidural analgesia during labour and delivery. Our aim was to determine whether wither opioid was superior when used with low dose local anaesthetic. METHODS: In a double-blind study patients were randomized to two epidural infusion groups: Group I (n = 50) fentanyl 2 micrograms.ml-1 with bupivacaine 0.015% and epinephrine 2 micrograms.ml-1, Group II(n = 50) sufentanil 1 microgram.ml-1 with bupivacaine 0.015% and epinephrine 2 micrograms.ml-1. Following a 20 ml bolus of the study solution an infusion was started at 10 ml.h-1. To achieve analgesia patients could receive two boluses of 5 ml of the study solution and if analgesia was still inadequate, a further 5 ml bupivacaine 0.25% was used. Pain and overall satisfaction were assessed with a 10-point visual scale. Plasma samples obtained from the mother at the time the infusion was discontinued and from the umbilical cord vein at delivery were assayed to determine opioid concentration. RESULTS: Pain scores were greater for Group I than for Group II patients throughout the first and second stages of labour (P = 0.002). More patients in Group I (42%) requested a dose of bupivacaine 0.25% than in Group II (6%) (P ` 0.001) and the total dose of bupivacaine given to Group I patients was greater than that of Group II, 26.0 +/- 22.0 mg vs. 13.4 +/- 12.6 mg, P = 0.005. There were no differences with respect to first or second stage duration, incidence of side effects, infusion duration, outcome of labour or neonatal Apgar scores. There was no opioid accumulation in either maternal or foetal blood. Conclusion: Epidural opioid infusion with very low dose bupivacaine (0.015%) achieved an overall high level of patient satisfaction in both groups without serious maternal or neonatal side effects. At the fentanyl-to-sufentanil ratio used here patients receiving sufentanil had lower pain scores and substantially fewer patients required bupivacaine rescue.
This article has been cited by other articles:
 |
|
 |
|
  G. Capogna, M. Camorcia, and M. O. Columb Minimum Analgesic Doses of Fentanyl and Sufentanil for Epidural Analgesia in the First Stage of Labor Anesth. Analg., April 1, 2003; 96(4): 1178 - 1182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-M. Bernard, D. Le Roux, A. Barthe, O. Jourdain, L. Vizquel, and C. Michel The Dose-Range Effects of Sufentanil Added to 0.125% Bupivacaine on the Quality of Patient-Controlled Epidural Analgesia During Labor Anesth. Analg., January 1, 2001; 92(1): 184 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Culebras, G. Gaggero, J. Zatloukal, C. Kern, and R.-A. Marti Advantages of Intrathecal Nalbuphine, Compared with Intrathecal Morphine, After Cesarean Delivery: An Evaluation of Postoperative Analgesia and Adverse Effects Anesth. Analg., September 1, 2000; 91(3): 601 - 605. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. Connelly, R. K. Parker, V. Vallurupalli, S. Bhopatkar, and S. Dunn Comparison of Epidural Fentanyl Versus Epidural Sufentanil for Analgesia in Ambulatory Patients in Early Labor Anesth. Analg., August 1, 2000; 91(2): 374 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kampe, C. Weigand, J. Kaufmann, M. Klimek, D. P. Konig, and J. Lynch Postoperative Analgesia with No Motor Block by Continuous Epidural Infusion of Ropivacaine 0.1% and Sufentanil After Total Hip Replacement Anesth. Analg., August 1, 1999; 89(2): 395 - 395. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
