Labour analgesia with intrathecal fentanyl decreases maternal stressPurpose: Lumbar epidural analgesia (LEA) decreases rnatemal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephrine (Epi) and norepinephrine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA.Methods: Twenty-four healthy women in active labour received either 25 pg ITF (n = 12) or epidural lidocaine 1.5% (n= 12) for analgesia. Venous blood samples were collected before anaesthesia and at frye minute intervals for 30 min following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores 0/AS) to pain and pruritus were recorded at the same time.Results: Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyl(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01 ).Conclusion: We conclude that ITF is as effective as LEA in producing pain relief in the labouring patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epinephrine concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamine during labour.Objectif : l'analgEsie 6pidurale Iombaire (AI~L) diminue le stress matemeI dEterminE par le dosage des concentrations plasmatiques de catEcholamines. Le fentanyl sous-arachno'l'dien (FSA) procure une analg&ie efficace pendant le travail mais on ne conna?t pas son influence sur les concentrations matemelles d'EpinEphdne (I~PI) et de norEpinEphrine (N~:). Cette Etude visait ,~ determiner si le FSA diminuait le stress de la rhyme fa~on que I'AI~L.M&hodes : Vingt-quatre parturientes bien portantes en travail ont re<;u pour I'analg&ie soit du FSA 25 pg (n = 12) soit de la lidocai'ne Epidurale 1,5% (n= 12). Des &hantillons de sang veineux ont EtE recueillis avant I'anesthEsie et ,~ des intervalles de cinq minutes pendant 30 min awes ranesthEsie dans le but de mesurer I'I~PI et la N~ plasmatiques par chromatog~phie en phase liquide ,~ haute performance. En mEme temps, la pression art&ielle (PA), la frEquence cardiaque et les scores d'une Echelle visuelle analogique (E-r'VA) pour la douleur et le prurit Etaient enregistrEs. Conclusion : Le FSA est aussi ef~cace que I'AI~L pour soulager la douteur chez la parturiente en travail. Le fentanyl sous-arachno'idien diminue aussi les concentrations maternelles d'6pinEphrine, protEgeant ainsi la parturiente en travail des effets nocifs de concentrations excessives de catEcholamines.

Meningitis following a combined spinalepidural technique in a labouring term parturient

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