Minimum Local Analgesic Dose of Intrathecal Bupivacaine in Labor and the Effect of Intrathecal Fentanyl

Stocks, Gary M.; Hallworth, S.; Fernando, Roshan; England, A. J.; Columb, Malachy O.; Lyons, G.

doi:10.1097/00000542-200104000-00011

Cited by 84 publications

(63 citation statements)

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“…Sample size estimations are based on a previous up-down sequential allocation study of intrathecal bupivacaine with varying doses of fentanyl in which the median (SD) local anesthetic dose of plain bupivacaine was estimated to be 1.99 (0.486) mg. 4 Using the two-sided Student's t test with an estimated standard deviation of 0.486 mg and assuming equal variance between groups, 15 patients per group were required to estimate a 25% difference C 0.5 mg at alpha = 0.05 (two-sided), with power of 0.8. Estimations of the ED50 and 95% CIs using the formula of Dixon and Massey are based on the sequence of successful or failed doses, whichever series includes fewer observations; 12 therefore, recruitment continued until a minimum number of 15 effective and ineffective outcomes were recorded for each group.…”

Section: Discussionmentioning

confidence: 99%

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The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

Mhyre

Hong

Greenfield

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Neuraxial hydromorphone has been reported to provide rapid onset of labour analgesia, effective segmental pain relief, and a longer duration of action than commonly used lipophilic opioids. This study was conducted to test the hypothesis that intrathecal hydromorphone reduces the dose requirement for intrathecal bupivacaine to induce rapid analgesia for women in the first stage of labour. Methods In this double-blind randomized controlled sequential allocation trial, 88 labouring parturients received combined spinal-epidural analgesia at 2-6 cm cervical dilation. Participants received intrathecal bupivacaine alone or bupivacaine plus hydromorphone 100 lg with the bupivacaine dose determined using updown sequential allocation. An effective dose was defined as a visual analogue pain score of B10 mm (on a 100-mm pain scale) reported within 20 min of injection. The median effective doses were calculated using the formula of Dixon and Massey and verified using isotonic regression. Results A decrease was observed in the median local analgesic doses (effective dose [ED50]) estimated according to the formulas of Dixon and Massey, with a between-group difference of -0.45 mg. The precision of the estimate was wide-ranging (95% confidence interval -1.23 to 0.33), so no definitive conclusion can be drawn. Conclusion Further research is needed to determine whether or not intrathecal hydromorphone 100 lg changes the dose of intrathecal bupivacaine required to induce labour analgesia within 20 min. Trial registration The trial was conducted in 2007 prior to widespread acceptance of the standard for clinical trial registration. RésuméObjectif Il a été décrit que l'hydromorphone administrée par voie neuraxiale favorisait l'installation rapide de

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Section: Discussionmentioning

confidence: 99%

“…The testing interval was bupivacaine 0.25 mg for all groups. 4 An investigator with no other study responsibilities (M.G.) implemented a simple randomization scheme in Excel by generating the sequence 1-100 and assigning the numbers 1-50 to control and 51-100 to hydromorphone.…”

Section: Methodsmentioning

confidence: 99%

The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

Mhyre

Hong

Greenfield

et al. 2013

Can J Anesth/J Can Anesth

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“…Sezaryen için düşük dozlarda bupivakainin (5-8 mg) opioidlerle birlikte kullanımı ile başarılı anestezi uygulamaları bildirilmiş-tir. [7,8] Ancak biz opioid kullanmadığımız için spinal grupta bupivakini rutinde kullanılan dozlarda (12.5 mg), KSEB grubunda ise spinal gruba göre oldukça düşük (7.5 mg) dozlarda uyguladık. Daha önce yapılan çalışmalarda da bildirildiği üzere KSEB uygulamasında düşük doz lokal anestezik ajan uygulanarak hızla spinal blok sağlanabilir ve daha sonra epidural ek dozlar ile duyusal blok seviyesi istenilen segmentlere genişletilebilir.…”

Section: Discussionunclassified

Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Uysallar¹,

Karaman²,

Günüşen³

et al. 2011

Agri

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Summary Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) ÖzetAmaç: Sezaryen operasyonlarında spinal bloğun güvenirliliği ve epidural bloğun kullanım esnekliklerini içeren kombine spinal-epidural bloğun kullanımı giderek artmaktadır (KSEB). Biz çalışmamızda KSEB ile spinal bloğun maternal ve fetal etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Miyadında 40 gebe randomize olarak iki gruba ayrıldı. KSEB grubuna intratekal 1.5 ml, spinal blok (SB) grubuna 2.5 ml %0.5 hiperbarik bupivakain uygulandı. KSEB grubunda bloğun uygulanmasından itibaren 10 dakika geçme-sine rağmen duyusal blok T4' e ulaşmamış ise epidural kateterden her bloke olmayan segment için 2 mL %0.5 bupivakain ilave edildi. Maternal hemodinamik etkiler, intraoperatif anestezi kalitesi ve yan etkiler, Apgar ve NAKS skorları ve postoperatif analjezi yönünden iki grup karşılaştırıldı. Bulgular: Duyusal bloğun T4' e ulaşma zamanı ve tam blok oluşma süresi SB grubunda KSEB' a göre istatistiksel olarak kısa saptandı (p<0.05). Ortalama arter basıncı ve kalp atım hızı SB grubunda düşük saptandı (p<0.05). Umblikal kord kan gazı değerleri, Apgar skoru, NAKS ve bulantı, kusma gibi yan etkiler açısından farklılık görülmedi. Sonuç: Hem spinal hem KSEB iyi bir cerrahi analjezi sağlamıştır. Maternal hipotansiyon her iki teknik için de risk olmakla birlikte, spinal blok ile daha erken ve derin olmaktadır. Maternal kan basıncının dikkatli monitörizasyonundan ve hipotansiyonun hemen tedavi edilmesinden dolayı neonatal açıdan fark saptanmamıştır.Anahtar sözcükler: Kombine spinal-epidural blok; spinal blok; sezaryen.

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“…The subarachnoid and epidural drug doses were standardized with each patient receiving subarachnoid bupivacaine 3.125 mg plus fentanyl 5 lg as the initial spinal dose (i.e., 0.125% bupivacaine 2.5 mL plus fentanyl 2 lgÁmL -1 ), well within the established range for intrathecal dosing. 4,11 The bedside nurse was instructed to give the study drug intravenously as a bolus within 60 sec of administration of the spinal dose. After the epidural catheter was securely placed, all patients were positioned in a left lateral position for at least 30 min after CSE placement, and the continuous FHR and uterine contraction monitors were repositioned.…”

Section: Methodsmentioning

confidence: 99%

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study

Gambling

Bender

Faron

et al. 2015

Can J Anesth/J Can Anesth

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Background The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB.Methods We conducted this clinical trial at a large community hospital and enrolled healthy patients requesting epidural analgesia for labour. Patients were randomly assigned to receive either normal saline placebo or ephedrine 10 mg iv at the time of CSE. The primary outcome of EPFB (defined as bradycardia \ 90 beatsÁmin -1 for [ two minutes and occurring within the first 30 min after CSE) was compared between groups. The secondary outcomes included the incidence of urgent cesarean delivery, the requirement for additional doses of ephedrine, maternal blood pressure, uterine hypertonus and tachysystole, and abnormal fetal heart rate (FHR) patterns before and after CSE. Results There were 299 women randomized to the ephedrine (EPH) group and 297 randomized to the normal saline placebo (NS) group. There was no difference between groups in the incidence of EPFB (2.7% EPH group vs 4.7% NS group; relative risk, 0.57; 95% confidence interval, 0.24 to 1.33; P = 0.184). There was also no difference between groups in the incidence of -015-0450-8 urgent cesarean delivery, uterine hypertonus, uterine tachysystole, and abnormal FHR patterns. Conclusions We conclude that prophylactic intravenous ephedrine administration at the time of CSE during labour was ineffective at reducing the risk for EPFB associated with CSE. Nevertheless, a lower than expected rate of EPFB resulted in the trial being underpowered. This trial was registered at ClinicalTrials.gov, identifier: NCT02062801.123 Can J Anesth/J Can Anesth (2015) 62:1201-1208 DOI 10.1007/s12630 RésuméContexte La technique rachidienne et péridurale combinée (RPC) pour soulager la douleur lors de l'accouchement procure à la fois un court délai d'action et une analgésie supérieure pour la première étape du travail obstétrical. Cependant, le risque accru connu de bradycardie foetale profonde précoce (BFPP) après une RPC est une inquiétude qui contribue bien souvent à freiner son utilisation. L'objectif de cette étude était de déterminer si l'administration prophylactique d'éphédrine intraveineuse au moment de l'administration de la RPC réduisait la BFPP. Méthode Nous avons réalisé cette étude clinique dans un hô pital communautaire d'envergure et enrô lé des patientes ayant demandé une analgésie péridurale pour le travail obstétrical. Les patientes ont été aléatoirement réparties en deux groupes et ont reçu soit un placebo de sérum physiologique ou 10 mg iv d'éphédrine au moment de la RPC. Nous avons comparé notre critère d'évaluation principal, la BFPP (définie comme une bradycardie \ 90 battementsÁmin -1 pour [ 2 minutes et survenant au co...

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Minimum Local Analgesic Dose of Intrathecal Bupivacaine in Labor and the Effect of Intrathecal Fentanyl

Cited by 84 publications

References 1 publication

The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study

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