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OBSTETRIC ANESTHESIA

The Dose-Range Effects of Sufentanil Added to 0.125% Bupivacaine on the Quality of Patient-Controlled Epidural Analgesia During Labor

Jean-Marc Bernard, MD, PhD^*, Daniel Le Roux, MD^*, Alexandre Barthe, MD^*, Olivier Jourdain, MD, Louis Vizquel, MD^*, and Claude Michel, MD

Département *d’Anesthésie-Réanimation and Clinique Gynécologique et Obstétricale, Polyclinique Jean-Villar, Bruges-Bordeaux, France

Address correspondence and reprint requests to Dr. Jean-Marc Bernard, Département d’Anesthésie-Réanimation, Polyclinique Jean-Villar, BP 61, F-33520 Bruges-Bordeaux, France. Address e-mail to jmbmdphd{at}club-internet.fr

To determine the minimal sufentanil concentration required to improve the quality of patient-controlled epidural analgesia during labor, we compared the efficacy of a combination of 0.125% bupivacaine with 1:800,000 epinephrine and different concentrations of sufentanil in a double-blinded randomized study. Concentrations were no sufentanil (n = 66), 0.078 µg/mL sufentanil (n = 65), 0.156 µg/mL sufentanil (n = 65), 0.312 µg/mL sufentanil (n = 65), and 0.468 µg/mL sufentanil (n = 67). The patient-controlled epidural analgesia setting was a 12-mL bolus dose and a 25-min lockout interval. Pain was scored at 5–6 cm, 7–8 cm, and full cervical dilation by using a 10-cm visual analog scale. At full cervical dilation, the pain scores were lower in the groups receiving a solution of at least 0.156 µg/mL sufentanil. Few differences were observed when using the larger concentrations, except for increased pruritus intensity. The duration of labor and the mode of delivery were similar in each group. Rescue analgesia, which consisted of 6 mL of 0.25% bupivacaine, was infrequent and comparable between groups. The use of the pump did not differ between groups. Adding a small concentration of sufentanil to 0.125% bupivacaine for patient-controlled epidural analgesia during labor improved the quality of analgesia but did not modify the bupivacaine requirement. Reducing the sufentanil concentrations to 0.156 µg/mL decreased the pruritus intensity without reducing analgesia.

Implications: Adding a small concentration of sufentanil to 0.125% bupivacaine for patient-controlled epidural analgesia during labor improved the quality of analgesia but did not modify the bupivacaine requirement. Reducing the sufentanil concentrations to 0.156 µg/mL decreased the pruritus intensity without reducing analgesia.

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