Walking with labor epidural analgesia: the impact of bupivacaine concentration and a lidocaine-epinephrine test dose.
Anesthesiology
; 92(2): 387-92, 2000 Feb.
Article
in En
| MEDLINE
| ID: mdl-10691224
ABSTRACT
BACKGROUND:
Regional analgesia techniques for labor that permit ambulation are popular among parturients. This study evaluated the influence of bupivacaine bolus concentration and a 3-ml 1.5% lidocaine-epinephrine test dose, on analgesic effectiveness and the ability to walk after block placement.METHODS:
Using a randomized double-blind study design, epidural analgesia was initiated in 60 parturients undergoing labor as follows Group TD/B.0625 received a 3-ml lidocaine-epinephrine test dose + 12 ml bupivacaine, 0.0625%; group TD/B.125 received a 3-ml test dose + 12 ml bupivacaine, 0.125%; group B.0625 received 15 ml bupivacaine, 0.0625% (no test dose); and group B.125 received 15 ml bupivacaine, 0.125% (no test dose). Initial boluses in all groups contained 10 microg sufentanil. Bupivacaine, 0.0625%, with 0.33 microg/ml sufentanil was infused throughout labor at 13.5-15 ml/h. Analgesia balance, proprioception, motor block, and patient ability to stand and walk were evaluated at various intervals.RESULTS:
A bolus of 0.125% bupivacaine containing sufentanil, without a previous test dose, proved to be optimal with respect to analgesia and early ambulation. When a test dose was given before bupivacaine, 0.125%, fewer women walked within 1 h of block placement. Bupivacaine, 0.0625%, with sufentanil, with or without a test dose, provided inadequate analgesia, necessitating additional bupivacaine, which impaired the ability to walk. A high percentage of women in all groups (73-93%) walked at some stage during labor.CONCLUSIONS:
Omitting a lidocaine-epinephrine test dose and using 0.125% bupivacaine for the initial bolus should permit ambulation in the early postblock period for most parturients who elect this option.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vasoconstrictor Agents
/
Bupivacaine
/
Analgesia, Epidural
/
Epinephrine
/
Analgesia, Obstetrical
/
Walking
/
Anesthetics, Local
/
Lidocaine
Type of study:
Clinical_trials
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
Anesthesiology
Year:
2000
Document type:
Article
Affiliation country:
United States
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA