A Villalonga — Page 4 | Search PubMed

OBJECTIVE: To assess the analgesic efficacy and the incidence of side effects of three procedures of epidural analgesia during labor. PATIENTS AND METHODS: One hundred and one nulliparous pregnant women at term with cephalic presentation were randomly allocated to 3 groups (A: 31, B: 35, C: 35). Group A was given an initial dose of 8 ml bupivacaine 0.25% (20 mg) with epinephrine 1/200,000 and 50 micrograms fentanyl followed by a continuous infusion of 8 ml/h bupivacaine 0.125% (10 mg/h) with epinephrine 1/400,000. The initial dose in group B was 10 ml bupivacaine 0.125% (12.5 mg) with epinephrine 1/400,000 and 50 micrograms fentanyl followed by a continuous infusion of 12 ml/h bupivacaine 0.0625% (7.5 mg/h) with epinephrine 1/800,000 and 12 micrograms/h fentanyl. In group C the initial dose was the same as for group A, but maintenance was provided through a patient-controlled (PCA) system with 5 ml bupivacaine 0.25% (12.5 mg) and epinephrine 1/200,000 set for a minimum interval of 1 h. If analgesia was inadequate all patients could receive top-ups of 5 ml bupivacaine 0.25% (12.5 mg) with epinephrine 1/200,000. RESULTS: Quality of analgesia was similar in all three groups. We found no significant differences in level of sensory/motor blockade, hemodynamic changes, side effects or type of delivery. The total dose of bupivacaine was highest in group A, whereas group B received the higher total dose of fentanyl. The number of Apgar scores under 8 was highest in group A, although the scores rose within 5 min of delivery in all cases. CONCLUSIONS: We believe that the protocol of choice is the one used with group B (initial dose of 10 ml bupivacaine 0.125% + epinephrine 1/400,000 + 50 micrograms fentanyl followed by 12 ml/h bupivacaine 0.0625% + epinephrine 1/800,000 + 12 mu cg/h fentanyl in continuous infusion). The use of PCA systems with our unscreened patients yielded no advantages over the procedure used with group B.

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