We compared the incidence of Caesarean delivery in nulliparous women randomized to receive epidural analgesia with those randomized to intramuscular (i.m.) pethidine. On admission to the delivery suite in established labour, 802 nulliparae had already agreed to be randomized with respect to their first analgesia. One hundred and eighty-eight women required either no analgesia or 50% nitrous oxide in oxygen (Entonox) only. Of the remaining 614 women, 310 were randomly allocated to receive i.m. pethidine up to 300 mg and 304 to receive epidural bupivacaine. Labour management was standardized according to the criteria for active management of labour. The intention-to-treat analysis showed similar Caesarean section rates in those randomized to epidural (12%) or pethidine analgesia (13%). The difference in Caesarean rate was -1.1% with 95% confidence intervals from -6.3% to +4.1%. The normal vaginal delivery rates were similar (epidural, 59%; pethidine, 61%).

SummaryThis study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n ¼ 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 mg for initiation of analgesia. Patients in the epidural group (n ¼ 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 mg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p ¼ 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p ¼ 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.

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We studied the effects of supplementing nitrous oxide-oxygen anaesthesia with halothane (1 MAC end-tidal concentration) on the motor evoked potential recorded in the extradural space of eight patients before corrective surgery for idiopathic adolescent scoliosis. The motor cortex was stimulated electrically through the scalp. An additional eight patients in whom anaesthesia was supplemented with an infusion of propofol acted as a control group. Halothane had no significant effect on the amplitude or latency of the motor evoked potential. We conclude that halothane is unlikely to alter the interpretation of motor evoked potentials recorded extradurally during scoliosis surgery.

Summary