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Effects of Diluent Volume of a Single Dose of Epidural Bupivacaine in Parturients During the First Stage of Labor
  1. Frank Christiaens, M.D.,
  2. Christian Verborgh, M.D., Ph.D.,
  3. Ann Dierick, M.D. and
  4. Frédéric Camu, M.D.
  1. From the Department Anesthesie, Akademisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium.
  1. Reprint requests: Christian Verborgh, M.D., Ph.D., Departement Anesthesie, Akademisch Ziekenhuis-V.U.B., Laarbeeklaan 101, B-1090 Brussels, Belgium.


Background and Objectives 0.1% bupivacaine for obstetric epidural analgesia is given by infusion, using a loading dose of a higher concentration alone or in combination with opioid analgesics. A single dose of 0.1% without any additive for relief of first-stage labor pain has not yet been documented.

Methods Fifty-eight primiparae in active labor and with less than 5 cm cervical dilatation received 20 mg epidural bupivacaine diluted in 4 mL [group 1: 0.5% (I)], 10 mL [group 2: 0.2% (II)], or 20 mL [group 3: 0.1% (III)]. Pain relief, dermatomal spread, and motor block were assessed.

Results Visual analog pain scale (VAS) was significantly lower in group 2 (0.88 ± 1.34) and group 3 (0.25 ± 0.61) than in group 1 (4.37 ± 2.57). Onset and time to maximum analgesia was significantly shorter in group 2 than in group 3. Mean duration of analgesia was 120 ± 21 minutes in group 3, 100 ± 26 in group 2, and 43 ± 21 in group 1. The mean numbers and upper limits of dermatomes blocked did not differ between groups 2 and 3, but were higher than in group 1. Motor blocks in groups 2 and 3 were more extensive than in group 1 with no difference between groups 2 and 3. Ten mL 0.2% or 20 mL 0.1% epidural bupivacaine results in a similar degree of pain relief, superior to that following 4 mL 0.5%, while duration was longest after 20 mL 0.1%.

Conclusions Analgesia lasts significantly longer following 20 mL 0.1% bupivacaine than following 10 mL 0.2% bupivacaine when given for first-stage labor pain. Four milliliters 0.5% bupivacaine results in inadequate pain relief.

  • epidural analgesia
  • obstetric analgesia
  • epidural anesthesia
  • local anesthetics
  • bupivacaine.

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