Spinal Analgesia in First Stage of Labour: Different drug combinations

Introduction: Combined Spinal Epidural technique is widely used in labour analgesia. It allows to start analgesia of the first stage of labour with low doses of local anesthetics or opiolds or a combination of both. Different regimens are used in the littérature. We performed a study to evaluate the best combination of intrathecal local anesthetics, epinephrin and opiolds in terms of duration of analgesia and pruritus. Methods: We randomized 72 labouring parturients requesting perimedullar analgesia in three groups. The first group ( I ) received 1.25mg plain bupivacaln with 25ug epinephrin and 25 g fentanyl. The secound group ( II ) received 2.5mg plain bupivacata with SOug epinephrin and 25ug fentanyl. The third group ( III ) received 1.25mg plain bupivacaln with 25jag epinephrin and Sug sufentanil. All solutions were given in a 2ml volume. We studied obstetric an demographic data along with duration of initial dose ( injection to next request ) and with incidence and severity of pruritus. Results: The three groups were obstetrically and demographically comparable. Mean durations of analgesia were not significantly different: 119.6 +/- 47.6 min. in group I, 127 +/- 24 min. in group II, 145 +/- 55.9 min. in group III. Incidence of pruritus in group I compared with group III was highly significant: 28 % and 77 % (P< 0.01); when we compared group I with group II, the difference was almost significant: 28% vs 54 % ( P= 0.06 ); when we compared group II with group III, the difference was not significant: 54 % vs 77 %. Pruritus was mild in all cases and did not require any treatment. Conclusion: Mean durations of analgesia were not significantly different. Using twice the dose of bupivacaln as in group II compared with group I did not prolong mean duration of analgesia. The addition of epinephrin did not have a positive effect on mean duration. Increasing the dose of epinephrin twofold seemed to increase the incidence of pruritus in group II (P=0.06). Sufentanil did not
SCOPUS: ar.j
info:eu-repo/semantics/published