Background and Objectives. We postulated that epidural sufentanil alone would provide adequate analgesia for labor and delivery. We also considered the possibility that a combination of epidural sufentanil and bupivacaine would demonstrate superior analgesia and fewer side effects when compared with either agent alone.
Methods. Using a randomized, double-blind design, parturients were prospectively assigned to receive intermittent 10-ml doses of 3 μg/ml sufentanil in saline (Group S), 1.5 μg/ml sufentanil in 0.125% bupivacaine (Group SB), or 0.25% bupivacaine (Group B). Lumbar epidural catheters were placed during the first stage of labor, and a test dose (3 ml 2% lidocaine with 15 μg epinephrine) was given, followed by coded study solution. Subsequent doses of study solution were given at the patient's request. Those parturients who remained uncomfortable after 30 minutes were given 10 ml 2% lidocaine and were designated efficacy failures. Patients were evaluated for quality and duration of analgesia for each dose. Neonates were assessed using Apgar scores and the neonatal behavioral assessment scale. Maternal and umbilical venous sufentanil concentrations were measured at the time of delivery.
Results. All patients received satisfactory analgesia of similar duration after the first epidural dose. After subsequent doses, women in Group S experienced more efficacy failures (Groups S, SB, and B, respectively, 12 of 26, 5 of 22, and 1 of 25; p < 0.005) and received briefer, less intense analgesia compared to the other groups. Instrumental delivery was performed more frequently for women in Group B (Groups S, SB, and B, respectively, 0 of 14, 2 of 17, and 7 of 24; p = 0.04). No serious maternal side effects occurred. Apgar and neurobehavioral scores were comparable for all groups, with the exception that Group B infants had higher irritability scores at 1 hour of age ( p = 0.003). Neither maternal nor umbilical venous sufentanil concentrations bore a consistent relationship to clinical outcomes.
Conclusions. Epidural sufentanil alone does not reliably provide satisfactory analgesia for labor and delivery. Addition of small amounts of local anesthetic to bolus doses of sufentanil enhances and prolongs the analgesic effect.
- anesthetic techniques
- local anesthetics
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Presented in part at the annual meeting of the American Society of Regional Anesthesia, Cincinnati, April 4-7, 1991.
Supported in part by a grant from Janssen Research Foundation, Inc., Piscataway, New Jersey.
The authors acknowledge the contributions of Karen Duprat, R.N., for patient recruitment and data analysis; George Powell, M.D., for patient management; Gordon Chapman, M.D., for assistance with early development of the protocols; Howard Cabral, M.P.H., for statistical analysis of the neonatal data; and Kristen Allsop, for manuscript preparation.