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Ambulatory Combined Spinal-Epidural Analgesia for Labor: Influence of Epinephrine on Bupivacaine-Sufentanil Combination
  1. Philippe E. Gautier, M.D.,
  2. François Debry, M.D.,
  3. Luc Fanard, M.D.,
  4. Albert Van Steenberge, M.D. and
  5. Jean-Luc Hody, M.D.
  1. Department of Anesthesiology, Clinique Ste. Anne-St. Remi, Brussels, Belgium
  1. Reprint requests: Philippe Gautier, Service d'Anesthésiologie, Clinique Ste. Anne-St. Remi, Boulevard Graindor 66, B-1070, Brussels, Belgium.


Background and Objectives Subarachnoid sufentanil 5 μg during labor is known to have variable results. However, subarachnoid sufentanil 5 μg plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 μg to this mixture.

Methods Forty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 μg and bupivacaine 1 mg with or without epinephrine 25 μg. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.

Results Addition of epinephrine prolonged the duration of analgesia from 103.8 ± 28.2 minutes to 142 ± 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.

Conclusions This minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 ± 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

  • labor analgesia
  • combined spinal-epidural analgesia
  • ambulatory
  • bupivacaine
  • epinephrine
  • sufentanil

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  • Presented in part at the annual meeting of the International Anesthesia Research Society, Washington, DC, March 1996.