Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?
Anaesthesia
; 67(6): 584-93, 2012 Jun.
Article
in En
| MEDLINE
| ID: mdl-22420645
ABSTRACT
Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 µg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 µg. Analgesia was assessed using a visual analogue pain score. When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Bupivacaine
/
Analgesia, Epidural
/
Analgesia, Obstetrical
/
Anesthetics, Local
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
Anaesthesia
Year:
2012
Type:
Article
Affiliation country:
United kingdom