Minimum Analgesic Doses of Fentanyl and Sufentanil for Epidural Analgesia in the First Stage of Labor

Capogna, G.; Camorcia, M.; Columb, Malachy O.

doi:10.1213/01.ane.0000054003.03645.cf

Cited by 36 publications

(34 citation statements)

References 20 publications

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“…Both doses were decided according to the median effective dose (ED50) of sufentanil for intrathecal and epidural adminis tration as published by Herman et al [12] and Capogna et al [6], respectively. At the reappearance of pain (Numeric Rating Scale (NRS) >4), analgesia was continued in both groups with the same protocol of epidural boluses of levobupivacaine + sufentanil according to cervical dilatation and conforming to our Institutional Protocol (Table 2).…”

Section: Interventionmentioning

confidence: 99%

“…The administration of perimedullary opioids in combination with lower concentration of local anesthetic has been gaining popularity to maintain some degree of motor function during the labor [1,3,4] and reduce local anesthetic requirements [5]. In this regard, Sufentanil has emerged as one of the most useful drugs for pain relief due to its potency (5-6 times that of fentanyl) [6], longer analgesic effect [7] and relatively safe profile. However, opioids have also been associated with dose-related side effects such as pruritus, respiratory depression and maternal hypotension [8].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Gallardo¹,

Meneghetti²,

Ripa³

et al. 2017

SOJPPS

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Background: Combined spinal epidural analgesia (CSEA) has become a widespread technique in obstetric analgesia. Sufentanil is currently widely used in combination with a low concentration of local anaesthetic to reduce both motor block and local anesthetic requirements. While some studies have reported on the hemodinamic changes after the intrathecal administration of sufentanil in the early phase of labor, no randomized controlled trials have been performed. We compared hemodynamic impact, quality of the analgesia, safety, side effects and impact on labor and delivery after the administration of two equipotent doses of sufentanil given by intrathecal versus epidural route.

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Section: Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Gallardo¹,

Meneghetti²,

Ripa³

et al. 2017

SOJPPS

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“…10 The potency ratio of epidural sufentanil:fentanyl was reported as 5:1 by Herman et al and 5.9:1 by Capogna et al, and they observed less side effects like somnolence and pruritus with sufentanil compared to fentanyl. 6,7 Sufentanil is preferred for epidural administration because of its high lipid solubility and high affinity for mu opioid receptors. It penetrates to spinal cord rapidly, leaving cerebrospinal fluid and this prevents the delayed respiratory depression.…”

Section: Group 1 Group 2 Pmentioning

confidence: 99%

“…Sufentanil is the most potent opioid. [2][3][4][5][6][7] Bupivacaine and sufentanil are frequently used together. 1,[8][9][10] However, the lowest doses that produce effective analgesia is still controversial.…”

mentioning

confidence: 99%

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

Çakirca¹,

Bektaş²,

Özcan³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Addition of opioids to local anesthetics for epidural obstetric analgesia provides effective analgesia with decreased side effects. We compared the analgesic quality of 0,0625% bupivacaine and 0,1% bupivacaine with 0.5 μg/mL sufentanil. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Study participants were 18-45-year-old, primiparous 30 parturients. An epidural catheter was placed, 8-10 mL of 0.0625% bupivacaine with 0.5 μg/mL sufentanil and 0.1% bupivacaine with 0.5 μg/mL sufentanil were given to Group I and Group II, respectively. Hemodynamic parameters, obstetric examination findings, pain grades, time to reach visual analog scale (VAS)<4 and the first dose interval were recorded. Satisfaction levels, motor and sensorial blocks, oxytocin and valetamate bromide consumption, side effects were assessed. Total and additional drug use, duration of second stage of the delivery, mean delivery times, instrumental delivery, Apgar scores, fetal heart rates and uterine contraction pressures were recorded. The percentage of participation of the parturients to the delivery was assessed. R Re es su ul lt ts s: : Median VAS values were significantly lower in Group II. Median VAS values were lower than 4 in both groups after 15 th minute. The time to the second analgesic dose was longer in Group II. Systolic, diastolic and mean arterial blood pressures were measured lower in Group II. Satisfaction scores were significantly higher in Group II. C Co on nc cl lu us si io on n: : In the present study, satisfactory analgesia was produced in both groups. Although median VAS scores were lower in Group II, VAS<4 could be reached in Group I. We concluded that 0.0625% bupivacaine+0.5 μg/mL sufentanil combination, as providing VAS<4, could be a preferable alternative to 0.1% bupivacaine+0.5 μg/mL sufentanil. K Ke ey y W Wo or rd ds s: : Analgesia, obstetrical; analgesia, epidural Ö ÖZ ZE ET T A Am ma aç ç: : Epidural obstetrik analjezi için lokal anesteziklere opioidlerin eklenmesi daha efektif bir analjezi sağlar ve yan etkileri azaltır. Biz bu çalışmada %0,0625 bupivakain ve %0,1 bupivakaine 0,5 mikrog/mL sufentanil ekleyerek analjezi kalitesini karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, 18-45 yaşları arasında, 30 primipar gebe dahil edildi. Epidural kateter yerleştirildikten sonra %0,0625 bupivakain ile 0,5 mikrog/mL sufentanil veya %0,1 bupivakain ile 0,5 mikrog/mL sufentanil sırasıyla Grup I ve Grup II olarak belirlendi ve 8-10 mL uygulandı. Hemodinamik parametreler, obstetrik muayene bulguları, ağrı düzeyleri, vizuel analo skala (VAS)<4 olma zamanı ve ilk analjezik gereksinim zamanı kayıt edildi. Memnuniyet dereceleri, motor ve duyusal blok, oksitosin ve valetamat bromür kullanımı ve yan etkiler değerlendirildi. Toplam ve ek ilaç kullanımı, doğumun 2. evresinin süresi, doğumun toplam süresi, doğumda yardımcı alet kullanımı, Apgar skorları, fetal kalp hızı ve uterin kontraksiyon basınçları kayıt edildi. Gebelerin doğuma katılı...

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“…Capogna et al determined the ED50 of epidural fentanyl and sufentanil using the MLAC methodology (194). To produce analgesia in 50% of patients a dose of 124 µg fentanyl and 21 µg sufentanil was required, establishing a potency ratio of 5.9 between sufentanil and fentanyl.…”

Section: Opioidsmentioning

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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Minimum Analgesic Doses of Fentanyl and Sufentanil for Epidural Analgesia in the First Stage of Labor

Cited by 36 publications

References 20 publications

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

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

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