ADDITION OF EPINEPHRINE TO INTRATHECAL BUPIVACAINE AND SUFENTANIL FORAMBULATORY LABOR ANALGESIA

Background: The intrathecal combination of sufentanil and bupivacaine provides rapid, effective analgesia for labor with a limited duration, Many anesthesiologists have concerns that the use of intrathecal loca l anesthetics precludes maternal ambulation. This prospective, randomi zed, double-blind study was designed to determine whether the addition of epinephrine to the combination of sufentanil and bupivacaine would prolong intrathecal analgesia for labor, Patients' ability to ambulat e was also assessed. Methods: Thirty-nine patients received either an intrathecal control dose of 10 mu g sufentanil plus 2.5 mg bupivacaine plus 0.2 ml normal saline (control group); or 10 mu g sufentanil plus 2.5 mg bupivacaine plus 0.2 ml (0.2 mg) of epinephrine (EPI group). R esults: Seven patients (3 control, 4 EPI) delivered vaginally and two (1 control, 1 EPI) required cesarean delivery before requesting epidur al analgesia. The duration (mean +/- SD) of intrathecal labor analgesi a was prolonged significantly by the addition of epinephrine: control (n = 15): 145 +/- 23 min; EPI (n = 15): 188 +/- 25 min (P < 0.0001), M aternal ambulation was demonstrated in 100% (19 of 19) of the control group and in 80% (16 of 20) of the EPI group (P = NS). Conclusions: Th e addition of 0.2 mg epinephrine to the intrathecal combination of suf entanil and bupivacaine significantly prolonged labor analgesia withou t causing adverse effects to the mother or fetus. The intrathecal comb ination of sufentanil and bupivacaine, with or without epinephrine, pr ovided rapid, profound labor analgesia and allowed most patients to am bulate.