The Influence of a Bupivacaine and Fentanyl Epidural Infusion After Epidural Fentanyl in Patients Allowed to Ambulate in Early Labor

Abstract

A 0.0625% bupivacaine and fentanyl (3 microg/mL) infusion, when added to epidural fentanyl (100 microg), prolongs the analgesic duration without increasing motor block in women in early labor.

The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour

“…14 In a study utilizing 40 µg epidural fentanyl with 20 mL 0.08% bupivacaine, the analgesic duration was shown to be 91 ± 24 min. 15 These times are significantly less than the analgesia in our previous studies of epidural opioids, [1][2][3][4] as well as in the current study (135-145 min). However, Breen et al's study population included both primigravidous and multigravidous patients.…”

“…We have successfully utilized epidural opioids following a lidocaine-epinephrine test dose to provide satisfactory analgesia without a significant motor block. [1][2][3][4][5][6] The current study compared 100 µg of fentanyl after a lidocaine and epinephrine test dose in primigravid patients with and without concomitant hydromorphone (300 µg). The goal of the hydromorphone was to prolong the duration of analgesia.…”

“…[1][2][3][4][5][6] The accidental dural puncture rate using the epidural technique has been reported to be 0.69-4.2%. 11,12 We had one accidental dural puncture in our study of 44 patients (with epidural catheters placed by residents in a teaching institution).…”

“…The analgesic duration in both groups in the current study is consistent with that of epidural fentanyl or sufentanil when utilized for labour pain management. [1][2][3][4] Whether the hydromorphone resulted in no effect due to a change in the intensity of pain as labour progressed (such that opioid alone is inadequate), or that the analgesic duration of hydromorphone in labour is not significantly different than that of fentanyl, remains unclear. A study of postCesarean delivery pain found no difference between epidural morphine 3 mg and hydromorphone 600 µg.…”

“…E previously showed that epidural fentanyl or sufentanil, after a lidocaine-epinephrine test dose, provides approximately two hours of analgesia, while allowing patients to ambulate. [1][2][3][4][5][6] Fentanyl is the most commonly chosen opioid at our institution for early labour ambulatory epidurals based on its low cost and the fact there was a lack of significant analgesic difference compared to sufentanil. 3 In a pilot study, hydromorphone 300 µg following a lidocaine-epinephrine test dose demonstrated an analgesic onset time of greater than 20 min, which was determined to be too long to be clinically useful.…”