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Anesth Analg 2002;94:927-932
© 2002 International Anesthesia Research Society

OBSTETRIC ANESTHESIA

A Comparison of Epidural Infusions in the Combined Spinal/Epidural Technique for Labor Analgesia

Yaakov Beilin, MD*{dagger}, Ashalatha Nair, MD*, Ittamar Arnold, BA*, Howard H. Bernstein, MD*{dagger}, Jeffrey Zahn, MD*, Sabera Hossain, MS{ddagger}, and Carol A. Bodian, DrPH{ddagger}

Departments of *Anesthesiology, {dagger}Obstetrics, Gynecology & Reproductive Sciences, and {ddagger}Biomathematical Sciences, Mount Sinai School of Medicine, New York, New York

Address correspondence and reprint requests to Yaakov Beilin, MD, The Mount Sinai Medical Center, Department of Anesthesiology, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6574. Address e-mail to YBeilin{at}mountsinai.org

We compared the clinical effects of three epidural infusions initiated after subarachnoid medication was administered as part of the combined spinal/epidural technique for labor analgesia. Fifteen minutes after administering subarachnoid fentanyl 25 µg and 1 mL of bupivacaine 0.25%, and 5 min after an epidural test dose of 3 mL of bupivacaine 0.25%, women were randomized to receive an epidural infusion of saline, bupivacaine 0.125%, bupivacaine 0.0625%, or bupivacaine 0.04% with epinephrine 1:600,000. All epidural infusions were started at 10 mL/h, and all except the Saline Group also received fentanyl 2 µg/mL. The end point of the study was delivery or request for additional medication for analgesia. We found that time until request for additional analgesia was longest in women who received bupivacaine 0.125% (median duration, 300 min) versus saline (median duration, 118 min) (P = 0.0001) and was intermediate for bupivacaine 0.0625% and bupivacaine 0.04% (median duration, 162 and 180 min, respectively) (P = 0.0001 versus saline). Women who received bupivacaine 0.125% had the most motor block. We conclude that all the bupivacaine-based infusions we tested maintained the analgesia from subarachnoid medication longer than saline, with the longest duration, but the most motor block, from bupivacaine 0.125%.

IMPLICATIONS: In this prospective, randomized, and double-blinded study we found that initiating an epidural infusion of bupivacaine 0.125% with fentanyl 2 µg/mL at 10 mL/h 15 min after subarachnoid fentanyl 25 µg with 1 mL of bupivacaine 0.25%, followed by an epidural test dose of 3 mL of bupivacaine 0.25%, maintained the analgesia for longer but with more motor block than with either bupivacaine 0.04% or bupivacaine 0.0625%.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2002 by the International Anesthesia Research Society.