Spinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia.

BACKGROUND AND OBJECTIVES

The purpose of this investigation was to evaluate the effectiveness and side effects of combined spinal-epidural (CSE) injection of a bupiv-acaine-sufentanil-epinephrine mixture during labor as compared with epidural analgesia alone.

METHODS

In a randomized trial, 63 parturients presenting for vaginal delivery received either epidural analgesia (10 mL) with 12.5 mg bupivacaine plus 10 micrograms sufentanil and 12.5 micrograms epinephrine or CSE analgesia with a single subarachnoid injection of 1 mg bupivacaine plus 5 micrograms sufentanil and 25 micrograms epinephrine (total volume, 2.5 mL). For this purpose a 29-gauge BD-Quincke spinal needle was used. All subsequent top-ups consisted of 10 mL of the mixture, as used for the patients who received epidural analgesia only.

RESULTS

Thirteen patients delivered without requesting a second injection. The time required to obtain satisfactory analgesia (visual analog score < or = 2.5 and/or > 50% improvement) was significantly shorter for those who received the subarachnoid mixture than for the epidural analgesia group (4.0 +/- 0.4 vs 10.4 +/- 0.5 minutes, respectively, P < .001). The duration of analgesia was longer for the CSE group (137.4 +/- 11.5 vs 106.4 +/- 11.8 minutes, P < .05), with more patients being pain-free for longer than 150 minutes (40 vs 8%, P < .05). Less bupivacaine was consumed in the group receiving the subarachnoid mixture (21.6 +/- 2.0 vs 30.7 +/- 2.1 mg, P < .01). Pruritus was more common following subarachnoid than following epidural injection of sufentanil (53.1 vs 25.8%, P < .05). Other side effects related to the injected drugs, such as motor impairment, hypotension, or nausea or vomiting, were not observed. Although all blocks were uneventful, moderate headache compatible with postdural puncture headache occurred in two patients of the CSE group, which necessitated a blood patch after 5 days.

CONCLUSIONS

The CSE mixture induced long-lasting analgesia, with fast onset and without motor block or hypotension. Pruritus and headache were the major drawbacks of this technique.