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Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects.
Can J Anaesth. 2007 Jan; 54(1):15-20.CJ

Abstract

PURPOSE

Baricity is an important determinant of block characteristics of the spinal component of a combined spinal epidural (CSE) for labour analgesia. This study compares the analgesic efficacy and side effects of intrathecally administered plain and hyperbaric bupivacaine (both with fentanyl) during active labour.

METHODS

Sixty-two women in active labour (cervical dilatation >or=5 cm and pain score > 5) were randomized in a prospective, single-blinded fashion to receive 2.5 mg of either hyperbaric or plain bupivacaine both combined with 15 microg of fentanyl as the spinal component of a CSE. The primary outcome was failure of satisfactory analgesia within ten minutes of the intrathecal injection as defined by a verbal pain score > 3. Secondary outcomes included need for rescue analgesia, hypotension, respiratory depression, nausea and vomiting, pruritus and sustained fetal bradycardia.

RESULTS

Sixty patients were analyzed. The failure rates were 20% in the hyperbaric group vs 0% in the plain group (P=0.024). The plain solution provided faster onset, higher sensory levels and less motor block at all times during the first 30 min. The incidence of both pruritus and sustained fetal bradycardia was 33% in the plain group and 10% in the hyperbaric group (P=0.03).

CONCLUSION

A plain rather than hyperbaric solution of bupivacaine 2.5 mg with fentanyl 15 microg provides a faster onset of analgesia, higher sensory levels and less motor block, while demonstrating an increased incidence of pruritus and sustained fetal bradycardia.

Authors+Show Affiliations

Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17197463

Citation

Rofaeel, Ayman, et al. "Intrathecal Plain Vs Hyperbaric Bupivacaine for Labour Analgesia: Efficacy and Side Effects." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 54, no. 1, 2007, pp. 15-20.
Rofaeel A, Lilker S, Fallah S, et al. Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects. Can J Anaesth. 2007;54(1):15-20.
Rofaeel, A., Lilker, S., Fallah, S., Goldszmidt, E., & Carvalho, J. (2007). Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 54(1), 15-20.
Rofaeel A, et al. Intrathecal Plain Vs Hyperbaric Bupivacaine for Labour Analgesia: Efficacy and Side Effects. Can J Anaesth. 2007;54(1):15-20. PubMed PMID: 17197463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects. AU - Rofaeel,Ayman, AU - Lilker,Suzanne, AU - Fallah,Shafagh, AU - Goldszmidt,Eric, AU - Carvalho,Jose, PY - 2007/1/2/pubmed PY - 2007/3/14/medline PY - 2007/1/2/entrez SP - 15 EP - 20 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 54 IS - 1 N2 - PURPOSE: Baricity is an important determinant of block characteristics of the spinal component of a combined spinal epidural (CSE) for labour analgesia. This study compares the analgesic efficacy and side effects of intrathecally administered plain and hyperbaric bupivacaine (both with fentanyl) during active labour. METHODS: Sixty-two women in active labour (cervical dilatation >or=5 cm and pain score > 5) were randomized in a prospective, single-blinded fashion to receive 2.5 mg of either hyperbaric or plain bupivacaine both combined with 15 microg of fentanyl as the spinal component of a CSE. The primary outcome was failure of satisfactory analgesia within ten minutes of the intrathecal injection as defined by a verbal pain score > 3. Secondary outcomes included need for rescue analgesia, hypotension, respiratory depression, nausea and vomiting, pruritus and sustained fetal bradycardia. RESULTS: Sixty patients were analyzed. The failure rates were 20% in the hyperbaric group vs 0% in the plain group (P=0.024). The plain solution provided faster onset, higher sensory levels and less motor block at all times during the first 30 min. The incidence of both pruritus and sustained fetal bradycardia was 33% in the plain group and 10% in the hyperbaric group (P=0.03). CONCLUSION: A plain rather than hyperbaric solution of bupivacaine 2.5 mg with fentanyl 15 microg provides a faster onset of analgesia, higher sensory levels and less motor block, while demonstrating an increased incidence of pruritus and sustained fetal bradycardia. SN - 0832-610X UR - https://www.unboundmedicine.com/medline/citation/17197463/Intrathecal_plain_vs_hyperbaric_bupivacaine_for_labour_analgesia:_efficacy_and_side_effects_ L2 - https://doi.org/10.1007/BF03021894 DB - PRIME DP - Unbound Medicine ER -