SPINAL ANALGESIA DURING LABOR WITH LOW-DOSE BUPIVACAINE, SUFENTANIL, AND EPINEPHRINE - A COMPARISON WITH EPIDURAL ANALGESIA

Background and Objectives. The purpose of this investigation was to ev aluate the effectiveness and side effects of combined spinal-epidural (CSE) injection of a bupivacaine-sufentanil-epinephrine mixture during labor as compared with epidural analgesia alone. Methods. In a random ized trial, 63 parturients presenting for vaginal delivery received ei ther epidural analgesia (10 mL) with 12.5 mg bupivacaine plus 10 mu g sufentanil and 12.5 mu g epinephrine or CSE analgesia with a single su barachnoid injection of 1 mg bupivacaine plus 5 mu g sufentanil and 25 mu g epinephrine (total volume, 2.5 mt). For this purpose a 29-gauge BD-Quincke spinal needle was used. All subsequent top-ups consisted of 10 mL of the mixture, as used for the patients who received epidural analgesia only. Results. Thirteen patients delivered without requestin g a second injection. The time required to obtain satisfactory analges ia (visual analog score less than or equal to 2.5 and/or > 50% improve ment) was significantly shorter for those who received the subarachnoi d mixture than for the epidural analgesia group (4.0 +/- 0.4 vs 10.4 /- 0.5 minutes, respectively, P <.001). The duration of analgesia was longer for the CSE group (137.4 +/- 11.5 vs 106.4 +/- 11.8 minutes, P <.05), with more patients being pain-free for longer than 150 minutes (40 vs 8%, P <.05). Less bupivacaine was consumed in the group receivi ng the subarachnoid mixture (21.6 +/- 2.0 vs 30.7 +/- 2.1 mg, P <.01). Pruritus was more common following subarachnoid than following epidur al injection of sufentanil (53.1 vs 25.8%, P <.05). Other side effects related to the injected drugs, such as motor impairment, hypotension, or nausea or vomiting, were not observed. Although all blocks were un eventful, moderate headache compatible with postdural puncture headach e occurred in two patients of the CSE group, which necessitated a bloo d patch after 5 days. Conclusions. The CSE mixture induced long-lastin g analgesia, with fast onset and without motor block or hypotension. P ruritus and headache were the major drawbacks of this technique.