0.0625-PERCENT BUPIVACAINE WITH 0.0002-PERCENT FENTANYL VIA PATIENT-CONTROLLED EPIDURAL ANALGESIA FOR PAIN OF LABOR AND DELIVERY

Objective: To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a tr aditional continuous epidural infusion for pain of labor and delivery. Design and Subjects: Forty-one women in established labor were random ized to receive either (a) 0.0625% bupivacaine with 2 mu g/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background in fusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 mu g/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Su pplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., x3) was admini stered for treatment of breakthrough pain upon patient request. The st udy protocol was double-blind and placebo-controlled. Outcome Measures : Visual analogue pain scores, motor strength, pinprick level of senso ry analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular stud y group.Results: The cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual anal ogue pain scores, intensity of motor blockade, and need for physician- administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achie ving analgesia comparable to patients receiving CEI. Conclusions: The results of this study show that 0.0625% bupivacaine with 2 mu g/ml of fentanyl is an effective analgesic combination when used via PCEA.