EPIDURAL DIAMORPHINE - A COMPARISON OF BOLUS AND INFUSION ADMINISTRATION IN LABOR

In a randomly allocated double blind study of 54 primigravidae, we exa mined the relative efficacy of the addition of diamorphine 3 mg to eit her an initial bolus or an infusion of bupivacaine. Both groups receiv ed an initial bolus of 10 ml of bupivacaine 0.25% followed by an infus ion of bupivacaine 0.1% at 10 ml.h(-1). Group I received diamorphine 3 mg in the bolus and group 2 received diamorphine 3 mg in the initial 100 ml of infusion solution. Both groups had comparable total bupivaca ine requirements. Analgesia, assessed by visual analogue scores, was s uperior at 7h in group 2, but was similar at all other times. Sedation scores were significantly lower in group 2 for the first 3h and the i ncidence of nausea was significantly lower in group 2. The addition of diamorphine, whether as a bolus to added to an infusion of bupivacain e, results in similar quality of analgesia, but there is a reduction i n side effects when diamorphine is administered in an infusion.