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OBSTETRIC ANESTHESIA

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

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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