Acta Anaesthesiologica Taiwanica
Volume 47, Issue 4 , Pages 167-172, December 2009

Optimizing Epidural Fentanyl Loading Dose for Early Labor Pain

  • Feng-Fang Tsai

      Affiliations

    • Department of Anesthesiology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Gong-Jhe Wu

      Affiliations

    • Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chen-Jung Lin

      Affiliations

    • Department of Anesthesiology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chi-Hsiang Huang

      Affiliations

    • Department of Anesthesiology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Shiou-Sheng Chen

      Affiliations

    • Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • ,
  • Li-Kuei Chen

      Affiliations

    • Department of Anesthesiology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorresponding author. Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, R.O.C.

Received 19 May 2008; received in revised form 3 July 2009; accepted 8 July 2009.

Article Outline

Objective

Sufficient sensory blockade between L1 and T10 is required to relieve visceral pain during early labor. We examined whether the addition of fentanyl to a loading dose of 0.0625% bupivacaine could provide dose-dependent analgesic effects on early-stage labor pain.

Methods

Sixty parturients who requested epidural analgesia for labor pain were enrolled and randomly allocated to one of three groups. Group A (n = 20) received 10 mL of 0.0625% epidural bupivacaine as a loading dose alone. Group B (n = 20) received the same bupivacaine loading dose in combination with 2 mg/mL fentanyl. Group C (n = 20) received the same loading bupivacaine dose plus 4 mg/mL fentanyl. All patients received diluted bupivacaine plus 2 mg/mL fentanyl at a rate of 10 mL/hr as a maintenance dose. Fifteen minutes later, we recorded the highest cephalic and lowest caudal anesthetized dermatomes, side effects, and the number of patients who asked for supplemental analgesia.

Results

The highest anesthetized cephalic dermatome was at the level of T12 (T9 – L1) in Group A, T9 (T8 – T12) in Group B and T7 (T5 – T9) in Group C (p < 0.05 among the three groups). Eleven patients (55%) requested supplemental bupivacaine for inadequate analgesia in Group A, six in Group B (30%), and none in Group C (0%). Pruritus was reported by seven (35%) patients in Group B and eight (40%) patients in Group C, but none in Group A.

Conclusion

The addition of fentanyl to epidural bupivacaine dose-dependently increased the analgesic effect and higher loading doses of fentanyl increased the dermatomic coverage. We suggest that 0.0625% bupivacaine plus 4 mg/mL fentanyl is the ideal loading dose to provide the greatest segmental analgesia for early labor pain with minimal side effects.

KEY WORDS:  analgesia, obstetrical , bupivacaine , fentanyl , labor pain

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Morgan B , Bulpitt CJ , Clifton P , Lewis PJ . Effectiveness of pain relief in labour: survey of 1000 mothers . Br Med J (Clin Res Ed) . 1982;285:689–690
  2. Philipsen T , Jensen NH . Epidural block or parenteral pethidine as analgesic in labour. A randomized study concerning progress in labor and instrumental deliveries . Eur J Obstet Gynecol Reprod Biol . 1989;30:27–33
  3. Justins DM , Francis D , Houlton PG , Reynolds F . A controlled trial of extradural fentanyl in labour . Br J Anaesth . 1982;54:409–414
  4. Skerman JH , Thompson BA , Goldstein MT , Jacobs MA , Gupta A , Blass NH . Combined continuous epidural fentanyl and bupivacaine in labor: a randomized study . Anesthesiology . 1985;63:A450
  5. Chestnut DH , Owen CL , Bates JN , Ostman LG , Choi WW , Geiger MW . Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine . Anesthesiology . 1988;68:754–759
  6. Cohen SE , Tan S , Albright GA , Halpern J . Epidural fentanyl/ bupivacaine mixtures for obstetric analgesia . Anesthesiology . 1987;67:403–407
  7. Elliott RD . Continuous infusion epidural analgesia for obstetrics: bupivacaine versus bupuvacaine-fentanyl mixture . Can J Anaesth . 1991;38:303–310
  8. Bromage PR . Epidural Anesthesia . Philadelphia: Saunders; 1978;
  9. Vercauteren M , Meert TF . Isobolographic analysis of the interaction between epidural sufentanil and bupivacaine in rats . Pharmacol Biochem Behav . 1997;58:237–242
  10. Lyons G , Columb M , Hawthorne L , Dresner M . Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent . Br J Anaesth . 1997;78:493–496
  11. Cherng CH , Wong CS , Ho ST . Epidural fentanyl speeds the onset of sensory block during epidural lidocaine anesthesia . Reg Anesth Pain Med . 2001;26:523–526
  12. Liu SS , Gerancher JC , Bainton BG , Kopacz DJ , Carpenter RL . The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl . Anesth Analg . 1996;82:98–102
  13. Coda BA , Brown MC , Risler L , Syrjala K , Shen DD . Equivalent analgesia and side effects during epidural and pharmacokinetically tailored intravenous infusion with matching plasma alfentanil concentration . Anesthesiology . 1999;90:98–108
  14. Singh H , Yang J , Thornton K , Giesecke AH . Intrathecal fentanyl prolongs sensory bupivacaine spinal block . Can J Anaesth . 1995;42:987–991
  15. Ginosar Y , Riley ET , Angst MS . The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration . Anesth Analg . 2003;97:1428–1438
  16. Eichenberger U , Giani C , Petersen-Felix S , Graven-Nielsen T , Arendt-Nielsen L , Curatolo M . Lumbar epidural fentanyl: segmental spread and effect on temporal summation and muscle pain . Br J Anaesth . 2003;90:467–473
  17. Chestnut DH , Laszewski LJ , Pollack KL , Bates JN , Manago NK , Choi WW . Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor . Anesthesiology . 1990;72:613–618
  18. Vertommen JD, Vandermeulen E, Van AH, Vaes L, Soetens M, Steenberge AV, et al  The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries . Anesthesiology . 1991;74:809–814
  19. Chaney MA . Side effects of intrathecal and epidural opioids . Can J Anaesth . 1995;42:891–903

PII: S1875-4597(09)60050-3

doi:10.1016/S1875-4597(09)60050-3

Acta Anaesthesiologica Taiwanica
Volume 47, Issue 4 , Pages 167-172, December 2009

Article Tools