A Comparative Study of Two Different Doses of Fentanyl Added to Bupivacaine for Intermittent Epidural Labor Analgesia: A Prospective Randomized Double Blind Study

Abstract

Background: Intermittent technique of labor epidural analgesia has been showing promising results over other techniques. This study was to assess and compare efficacy of two different doses of fentanyl mixed with low doses of bupivacaine in intermittent labor epidural analgesia.Methods: 90 ASA grade I-II parturients in active labor with a cervical dilatation of 3 to 5cm were randomly allocated to three different groups-Group A: 10ml Bupivacaine 0.125% + fentanyl 10µg (1µg/ ml).Group B: 10ml Bupivacaine 0.125% + fentanyl 20µg (2µg/ ml).Group C: 10ml Bupivacaine 0.125% (The control group).All patients were preloaded with 10-15ml/kg Lactated Ringer's solution. Labor analgesia was maintained by intermittent boluses of the drug combination. Results:The mean time of onset of analgesia was significantly lower (P<0.05) and the duration of analgesia was significantly higher (p<0.01) in Group B when compared with Group A and group C (p<0.001). The patients satisfaction was considerably better observed in Group B (p<0.01). However in both group's progression of labor was found to be slightly prolonged than group C. The level of sensory and the motor block was comparable in both the groups was at T8-T10 level and it was comparable and level of motor blockade (bromage score=0, 1) in each group was also not significant (p>0.05). Conclusion:Addition of fentanyl (2µg/ml) to bupivacaine 0.125% decreases the time of onset of analgesia and increases the duration of analgesia and level of maternal satisfaction during labor as compared to fentanyl (1µg).difficult and associated with an increased incidence of side effects like nausea, vomiting, pruritus along with use of opioids [4]. Although rarely with meningitis also been reported [5].The greatest advantage of implementing intermittent lumber epidural for labor analgesia is the lack of need of volume elastomeric epidural infusion pump; making its worth role in conducting deliveries in emergency settings, primary, secondary and tertiary health centres of developing countries (india etc.) where these facilities are not easily available but do have the human resources to provide the intermittent top-ups.Our study was designed to evolve a appropriate dose combination of bupivacaine and fentanyl in extradural labor analgesia using

Epidural Fentanyl Speeds the Onset of Sensory and Motor Blocks During Epidural Ropivacaine Anaesthesia

“…Incidence of complications in both epidural fentanyl and intravenous fentanyl group analysed with one-way ANOVA test, which gave a p-value >0.05 (0.135) showing statistical insignificance. Similar results are found by Cherng CH et al (8) Tomar GS et al (19) Chen-Hwan Cherng et al (20) …”

“…The p-value is >0.05 indicating insignificant differences among the anthropometric variables among the groups. Similar results among the anthropometric variables is found by Tomar GS et al (19) while comparing two different doses of fentanyl added to bupivacaine for intermittent epidural labour analgesia. They analysed demographic data using ANOVA test and found a p-value of >0.05 concluding there is no significant difference in the study groups.…”

COMPARISON BETWEEN FENTANYL 2 μG/mL VERSUS DEXMEDETOMIDINE 1.5 μG/mL AS ADJUVANTS WITH ISOBARIC BUPIVACAINE 0.0625% IN EPIDURAL LABOUR ANALGESIA

“…Tomar et al found that epidural fentanyl 2 µg/mL is better than 1 µg/mL when combined with bupivacaine in intermittent bolus technique as it leads to faster onset, longer duration of analgesia, higher maternal satisfaction, lesser drug requirement of local anaesthetic with comparable side effect profile. 20 Hence, our study has chosen an optimum dose 2 µg/mL of fentanyl as well. Bajwa et al in lower limb orthopaedic surgeries have shown dexmedetomidine to be a better alternative to fentanyl as an epidural adjuvant as it provides comparable stable haemodynamics, early onset of sensory anaesthesia, prolonged postoperative analgesia, lower consumption of postoperative local anaesthetics for epidural analgesia and much better sedation levels.…”

Anesthesia and Intensive Care

“…Intermittent technique of labor epidural analgesia [24] has been showing promising results over other techniques. This study was to assess and compare efficacy of two different doses of fentanyl mixed with low doses of bupivacaine in intermittent labor epidural analgesia.…”