THE DERMATOMAL SPREAD OF EPIDURAL BUPIVACAINE WITH AND WITHOUT PRIOR INTRATHECAL SUFENTANIL

Clinicians often use a technique combining intrathecal sufentanil and epidural bupivacaine to provide labor analgesia. This study determines the effect of 27- or 24-gauge dual puncture and intrathecal sufentani l 10 mu g on the dermatomal spread of epidural bupivacaine. Healthy la boring women received no dual puncture (n = 77) (no puncture group [NP G]) or dual puncture with a 27-gauge Whitacre needle (n = 33) or a 24- gauge Sprotte needle (n = 37) and intrathecal sufentanil 10 mu g (dual puncture group [DPG]) before epidural injection of 13 mL bupivacaine 0.25%. More dermatomes were anesthetized in the DPG, 16.6 +/- 7.5 vs 1 3.6 +/- 6.6 in the NPG (P < 0.02). More patients in the DPG had sensor y blockade T-4 or higher (17 of 70 DPG patients vs 8 of 77 NPG patient s; P < 0.05). No patient in either group showed clinical evidence of r espiratory compromise. In conclusion, epidural bupivacaine anesthetize d more dermatomes when administered 104 +/- 42 min after dural punctur e and intrathecal sufentanil 10 mu g than when given without prior dur al puncture and intrathecal injection.