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OBSTETRIC ANESTHESIA

Small Dose Bupivacaine-Fentanyl Spinal Analgesia Combined with Morphine for Labor

Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA

Address correspondence and reprint requests to Philip E. Hess, St. 308, Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Address e-mail to phess{at}caregroup.harvard.edu

We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 µg of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 µg of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 ± 0.14 episodes per hour versus 0.26 ± 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 ± 3.7 doses versus 4.7 ± 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief.

IMPLICATIONS: A small dose of intrathecal fentanyl 12.5 µg and bupivacaine 2 mg produces effective labor analgesia lasting for approximately 85 min. The addition of a small 125-µg dose of morphine improves pain control during subsequent epidural analgesia and reduces the requirements for postpartum pain medications.

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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