EPIDURAL-ANESTHESIA FOR LABOR IN AN AMBULATORY PATIENT

The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl , a 75-mug bolus and an infusion of fentanyl 2.5 mug/mL at 15 mL/h (FE NT, n = 53). A second group received ultra low-dose bupivacaine (0.04% ), epinephrine (1.7 mug/mL), and fentanyl (1.7 mug/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia w as rapidly obtained in 90.6% of patients in the FENT group and 92.2% o f patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixtu re provided analgesia of longer duration (287 +/- 171 min versus 156 /- 72 min, P = 0.0001). The number of patients delivering during admin istration of only their study drug (without needing higher doses of lo cal anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip fl exion weakness precluding ambulation occurred in 17% (P = 0.002) of BE F patients and orthostatic hypotension in 9% (P = 0.08). Neither probl em occurred in FENT patients. Neonatal outcome was similar in both gro ups. Approximately 70% of women receiving epidural analgesia with fent anyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambu late safely during labor.