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OBSTETRIC ANESTHESIA

Intrathecal Sufentanil and Fetal Heart Rate Abnormalities: A Double-Blind, Double Placebo-Controlled Trial Comparing Two Forms of Combined Spinal Epidural Analgesia with Epidural Analgesia in Labor

M. Van de Velde, MD, PhD^*, A. Teunkens, MD^*, M. Hanssens, MD, PhD, FRCOG, E. Vandermeersch, MD, PhD^*, and J. Verhaeghe, MD, PhD

Departments of *Anesthesiology and Obstetrics and Gynecology, University Hospitals Gasthuisberg, Katholieke Universiteit Leuven, Herestraat, Belgium

Address correspondence and reprint requests to Marc Van de Velde, MD, PhD, Director Obstetric Anesthesia and Extra Muros Anesthesia, Department of Anesthesiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Address e-mail to marc.vandevelde{at}uz.kuleuven.ac.be

Combined spinal epidural analgesia (CSE) for labor pain relief has become increasingly popular. However, the effect of intrathecal sufentanil on the incidence of uterine hyperactivity and fetal heart rate (FHR) abnormalities remains controversial. We hypothesized that the use of intrathecal sufentanil in a dose of 7.5 µg is more likely to induce a nonreassuring FHR tracing than a small dose of spinal sufentanil combined with bupivacaine or epidural analgesia. Three-hundred parturients were randomized into three groups. In the first group, epidural analgesia was initiated with 12.5 mg of bupivacaine, 12.5 µg of epinephrine, and 7.5 µg of sufentanil in a volume of 10 mL (EPD group). In Group 2, initial intrathecal analgesia consisted of 2.5 mg of bupivacaine, 2.5 µg of epinephrine, and 1.5 µg of sufentanil (BSE group); in Group 3, spinal analgesia consisted of 7.5 µg of sufentanil (SUF group). Analgesia was maintained in all groups with patient-controlled epidural analgesia using bupivacaine 0.125%, 1.25 µg/mL of epinephrine, and 0.75 µg/mL of sufentanil (bolus, 4 mL; lockout, 15 min). Cardiotocography was monitored continuously 15 min before analgesia and for 60 min after the start of analgesia. The quality of analgesia, labor, and neonatal outcome and side effects were recorded. Twenty-four percent of patients in the SUF group developed FHR abnormalities (bradycardia or late decelerations) during the first hour after initiation of analgesia compared with 12% in the BSE group and 11% in the EPD group. Uterine hyperactivity occurred in 12% of parturients in the SUF group but in only 2% in the other groups. Onset of analgesia was more rapid in both CSE groups as compared with the EPD group. However, 29% of patients in the BSE group developed severe hypotension, requiring IV ephedrine (29% in the BSE group versus 7% and 12% in the EPD and SUF groups, respectively). All these differences reached statistical significance. The present data corroborate previous recommendations of caution when performing CSE using a large dose (7.5 µg or more) of spinal sufentanil because of the risk of uterine hyperactivity and FHR abnormalities.

IMPLICATIONS: Combined spinal epidural analgesia (CSE) produces pain relief during labor. Fetal heart rate changes after CSE using intrathecal sufentanil have been reported. We performed a randomized, blinded trial confirming that fetal heart rate changes are more frequent after CSE using 7.5 µg of intrathecal sufentanil as compared with other forms of neuraxial labor analgesia.

This article has been cited by other articles:

				R. Preston The role of combined spinal epidural analgesia for labour: is there still a question?/Le role de l'analgesie rachidienne-peridurale combinee pour le travail obstetrical : y a-t-il encore une question ? Can J Anesth, January 1, 2007; 54(1): 9 - 14. [Full Text] [PDF]

				A. Rofaeel, S. Lilker, S. Fallah, E. Goldszmidt, and J. Carvalho Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects: [Bupivacaine intrathecale pure vs hyperbare pour l'analgesie du travail obstetrical : efficacite et effets secondaires] Can J Anesth, January 1, 2007; 54(1): 15 - 20. [Abstract] [Full Text] [PDF]

				J. Cleary-Goldman, M. Negron, J. Scott, R. A. Downing, W. Camann, L. Simpson, and P. Flood Prophylactic Ephedrine and Combined Spinal Epidural: Maternal Blood Pressure and Fetal Heart Rate Patterns Obstet. Gynecol., September 1, 2005; 106(3): 466 - 472. [Abstract] [Full Text] [PDF]

				J. S. Lee and M. V. de Velde Does Intrathecal Sufentanil Really Cause More Episodes of Fetal Bradycardia? * Response Anesth. Analg., October 1, 2004; 99(4): 1267 - 1267. [Full Text] [PDF]

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