Intrathecal Sufentanil for Labor Analgesia

Camann, William; Minzter, Beth H.; Denney, R.; Datta, Sanjay

doi:10.1097/00000542-199305000-00010

Cited by 114 publications

(38 citation statements)

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“…Many authors have studied epidural 5,6 and CSE techniques separately for labour analgesia 2,7,8,9 but few have compared them with each other. The few studies that have compared them, have included an epidural technique with a relatively high concentration of local anesthetic such as bupivacaine 0.25%, [10][11][12] or a CSE technique with morphine or with a low dose of sufentanil and bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of combined spinal-epidural and low dose epidural for labour analgesia

Hepner

Gaiser

Cheek

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour.Methods: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, doubleblind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n=24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local anesthetic sodium bicarbonate 8.4% and epinephrine 1:200, 000. The CSE group (n=26) received intrathecal 25 µg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request.Results: There were no differences (P > 0.05) in time to perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes < three: 26/26 vs 17/24, P ± 0.001). Conclusion:Although epidural analgesia with a low concentration of local anesthetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE.Objectif : Comparer l'analgésie rachidienne-péridurale combinée (RPC) à l'analgésie péridurale concernant le temps nécessaire à la réalisation de la technique et à l'induction, le blocage moteur, le délai d'installation de l'analgésie et la satisfaction de la patiente pendant le travail obstétrical.Méthode : Au moment de la demande d'analgésie, 50 parturientes à terme réparties de façon aléatoire ont reçu soit une analgésie RPC, soit une analgésie péridurale lombaire pour participer à une étude prospective en double insu. Le groupe péridural (n=24) a reçu un mélange bupivacaïne 0,0625 %-fentanyl 0,0002 % avec un ajout de 0,05 ml (par 10 ml d'anesthésique local) de bicarbonate de sodium à 8,4 % et de l'épinéphrine 1:200 000. Le groupe RPC (n=26) a reçu une injection intrathécale de 25 µg de fentanyl et de 2,5 mg de bupivacaïne. L'analgésie supplémentaire a été administrée sur demande.Résultats : Il n'y a eu aucune différence intergroupe (P > 0,05) quant au temps nécessaire à la réalisation de chacune des techniques et à l'atteinte du blocage moteur, à la satisfaction des patientes et au nombre d'interventions de l'anesthésiologiste appelé sur demande. Le premier signe d'analgésie est survenu au même temps dans les deux groupes, mais le début de l'analgésie complète est survenu plus rapidement dans le groupe RPC (Score à l'Échelle Visuelle Analogique, SEVA, à cinq minutes < trois : 26/26 vs 17/24, P ± 0,001).Conclusion : L'analgésie péridurale complète réalisée avec une faible concentration d'anesthésique local et un mélange d'opioïdes connaît une installation plus lente que l'analgésie RPC, mais elle en constitue une solution de remplacement s...

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Section: Discussionmentioning

confidence: 99%

Comparison of combined spinal-epidural and low dose epidural for labour analgesia

Hepner

Gaiser

Cheek

et al. 2000

Can J Anesth/J Can Anesth

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“…2,4,[16][17][18] In this study the addition of epinephrine to sufentanil reduced the number of subjects reporting sedation and lightheadedness in the first 45 min after epidural initiation. The number of subjects reporting a greater than 50% increase in VASS was significantly higher in the control group.…”

Section: Discussionmentioning

confidence: 99%

Epinephrine reduces the sedative side effects of epidural sufentanil for labour analgesia

Armstrong

Kennedy

Watson

et al. 2002

Can J Anesth/J Can Anesth

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“…A lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1)(2)(3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4)(5)(6)(7)(8)(9).…”

Section: Initiation Of Neuraxial Analgesiamentioning

confidence: 99%

“…following intrathecal injection (1,2,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Following conventional epidural analgesia, initial analgesia is usually achieved between 15 and 25 minutes.…”

Section: Initiation Of Neuraxial Analgesiamentioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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Intrathecal Sufentanil for Labor Analgesia

Cited by 114 publications

References 0 publications

Comparison of combined spinal-epidural and low dose epidural for labour analgesia

Comparison of combined spinal-epidural and low dose epidural for labour analgesia

Epinephrine reduces the sedative side effects of epidural sufentanil for labour analgesia

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

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