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Anesth Analg 2003;97:873-877
© 2003 International Anesthesia Research Society

OBSTETRIC ANESTHESIA

Hyperbaric Bupivacaine 2.5 mg Prolongs Analgesia Compared with Plain Bupivacaine When Added to Intrathecal Fentanyl 25 µg in Advanced Labor

Wendy H. L. Teoh, MBBS, and Alex T. H. Sia, MMed

Department of Anesthesia, KK Women’s & Children’s Hospital, Singapore

Address correspondence and reprint requests to Wendy H. L. Teoh, MBBS, Department of Anesthesia, KK Women’s & Children’s Hospital, 100 Bukit Timah Rd., Singapore 229899. Address e-mail to wendy_teoh{at}hotmail.com

We investigated the effect of sequential administration of intrathecal (IT) hyperbaric bupivacaine (after the initial administration of IT hypobaric fentanyl) on the duration of spinal analgesia. Thirty-seven nulliparous parturients with a cervical dilation >=5 cm were randomized to receive either IT fentanyl 25 µg and plain bupivacaine 2.5 mg (group P; n = 19) or IT fentanyl 25 µg and hyperbaric (with 8% glucose) bupivacaine 2.5 mg (group H; n = 18). The two components of the IT injectate were administered sequentially (fentanyl 25 µg diluted in 2 mL of normal saline, immediately followed by 0.5 mL of 0.5% bupivacaine). Patients were then positioned with their torso elevated at 30° for 30 min. Pain scores using 0–100 visual analog scales were collected before combined spinal/epidural analgesia and at 5, 15, and 30 min after the block. Patients in Group H had a longer median duration of analgesia (122 min; range, 80–210 min) than Group P (95 min; range, 75–125 min) (P < 0.01). Group H also had a more limited dermatomal spread (median highest sensory level of T8 versus T4 in group P; P < 0.05). The side-effect profile was similar. Under these circumstances, hyperbaric bupivacaine conferred an increased duration of IT analgesia compared with plain bupivacaine.

IMPLICATIONS: For late labor pain, the effect of intraspinal injection of bupivacaine with a higher density than cerebral spinal fluid lasts longer than a similar dose of bupivacaine with a lower density. There were no additional side effects with this technique.




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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 © 2003 by the International Anesthesia Research Society.