16690
document
Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil : combined spinal-epidural vs. epidural analgesia alone . BACKGROUND AND OBJECTIVE Combined spinal-epidural is an alternative technique to epidural analgesia for labour , but its benefits are not clearly identified . METHODS A prospective , blinded , randomized study was undertaken involving 113 women attending a university hospital obstetric department . Analgesia was initiated with intrathecal bupivacaine 0.25 % 1 mL + sufentanil 5 microg in the combined spinal-epidural group ( n = 54 ) , and with bupivacaine 0.125 % + epinephrine 2.5 microg mL ( -1 ) + sufentanil 7.5 microg in the epidural group ( n = 59 ) . In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125 % ( + sufentanil 0.25 microg mL ( -1 ) ) . Duration of labour , quality of analgesia and side-effects were compared between groups . RESULTS In the combined spinal-epidural group , the onset of analgesia was faster ( 5 vs. 15 min , P < 0.001 ) , the consumption of bupivacaine was lower ( 7.5 vs. 11.3 mg h ( -1 ) , P = 0.003 ) and there was less unilateral analgesia ( 14.8 % vs. 40.7 % , P = 0.002 ) than in the epidural group . The characteristics of labour were similar in both groups . However , in the combined spinal-epidural group , there was a higher incidence of posterior presentation ( 25.9 % vs. 10 % , P = 0.03 ) , pruritus ( P < 0.001 ) , hypotension ( P = 0.002 ) , somnolence ( P = 0.01 ) , nausea ( P = 0.02 ) and one case of meningitis . CONCLUSIONS The combined spinal-epidural technique provided more effective analgesia during labour than epidural analgesia alone but offered no other advantage . It induced more adverse effects and this should be considered before routinely using the combined spinal-epidural technique .
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
sufentanil
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Intervention_Pharmacological
spinal-epidural vs. epidural
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Intervention_Pharmacological
bupivacaine 0.25 % 1 mL
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Intervention_Pharmacological
sufentanil 5 microg
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Intervention_Pharmacological
bupivacaine 0.125 %
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Intervention_Pharmacological
epinephrine 2.5 microg mL ( -1 )
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Intervention_Pharmacological
sufentanil 7.5 microg
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Intervention_Pharmacological
In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125 %
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Intervention_Pharmacological
sufentanil 0.25 microg mL ( -1 ) )
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Intervention_Pharmacological
bupivacaine
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Outcome_Other
quality of analgesia
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Outcome_Adverse-effects
side-effects
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Outcome_Physical
unilateral analgesia
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Outcome_Other
characteristics of labour
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Outcome_Adverse-effects
incidence of posterior presentation
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Outcome_Adverse-effects
pruritus
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Outcome_Adverse-effects
hypotension
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Outcome_Adverse-effects
somnolence
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Outcome_Adverse-effects
nausea
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Outcome_Adverse-effects
meningitis
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Participant_Sample-size
113
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Participant_Sex
women
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Participant_Condition
during labour