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OBSTETRIC ANESTHESIA

Reduced Duration of Intrathecal Sufentanil Analgesia in Laboring Cocaine Users

Vernon H. Ross, MD, Charles H. Moore, PhD^*, Peter H. Pan, MD, Regina Y. Fragneto, MD, Robert L. James, MS Mstat, and Gina B. Justis, MD^*

*Department of Anesthesiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia; the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; the University of Kentucky College of Medicine, Lexington, Kentucky

Address correspondence and reprint requests to Dr. Vernon H. Ross, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157–1009. Address email to vhross{at}wfubmc.edu

On the basis of our previous clinical experience, we hypothesized in this study that the duration and/or quality of labor analgesia produced by intrathecal sufentanil was less in cocaine-abusing parturients compared with nonabusing parturients. Ten µg of sufentanil was given intrathecally as part of a combined spinal-epidural (CSE) technique to two groups of laboring parturients: 1) those whose urine tested positive for cocaine (cocaine group), and 2) those whose urine tested negative for cocaine (control group). The epidural catheter was not injected with local anesthetic until the patient requested additional pain relief. The time from injection of intrathecal sufentanil until patient request for additional pain relief was defined as duration of analgesia. Baseline visual analog pain score (VAPS) and cervical dilation were measured before the CSE was performed. After injection of intrathecal sufentanil, VAPS was recorded at specific intervals. Cervical dilation was again documented when the patient requested additional analgesia. We found that both groups reported high baseline VAPS and a marked decrease in VAPS after injection of sufentanil that did not differ between groups. Geometric mean duration of pain relief with adjustment for cervical dilation was 87 min in the cocaine group compared with 139 min in the control group (P = 0.019). All patients experienced itching. We conclude that intrathecal sufentanil produces a similar quality but shorter duration of analgesia in cocaine-abusing parturients compared with nonabusing parturients.

IMPLICATIONS: Intrathecal sufentanil administered as part of a combined spinal-epidural technique produces similar quality but reduced duration of labor analgesia in cocaine-abusing parturients compared with nonabusing parturients.