AMBULATORY COMBINED SPINAL-EPIDURAL ANALGESIA FOR LABOR - INFLUENCE OF EPINEPHRINE ON BUPIVACAINE-SUFENTANIL COMBINATION

Background and Objectives. Subarachnoid sufentanil 5 mu g during labor is known to have variable results. However, subarachnoid sufentanil 5 mu g plus bupivacaine 1 mg provides good quality labor analgesia of 1 00 minutes' average duration. The objective of this study was to exami ne the effects of adding epinephrine 25 mu g to this mixture. Methods. Forty-two parturients with less than 5 cm cervical dilation participa ted in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 mu g and bupivacaine 1 mg with or without epinephrine 25 mu g. Analgesia was assessed by visual analog scores. Time elapsed until first reques t for additional analgesia, blood pressure, heart rate, sensory levels , motor block, and incidence of pruritus, nausea, and sedation were no ted. Results. Addition of epinephrine prolonged the duration of analge sia from 103.8 +/- 28.2 minutes to 142 +/- 54.3 minutes and lowered th e median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performan ce; 19 patients were able to ambulate in each group. Conclusions. This minimal bupivacaine-sufentanil-epinephrine mixture allows high-qualit y analgesia of 142 +/- 54.3 minutes' duration, with a low sensory bloc k level and no motor block. However, hypotension can occur as a late s ide effect.