Background:The intermittent technique of labor extradural analgesia has been showing promising results over other techniques. This study was done to assess and compare the efficacy of two different doses of fentanyl mixed with low doses of bupivacaine in intermittent labor extradural analgesia.Materials and Methods:90 ASA grade I-II parturients in active labor with a cervical dilatation of 3–7 cm were randomly allocated to three different groups: Group A: 10 ml bupivacaine 0.125% + fentanyl 10 μg (1 μg/ml)Group B: 10 ml bupivacaine 0.125% + fentanyl 20 μg (2 μg/ml)Group C: 10 ml bupivacaine 0.125% (the control group) All patients were preloaded with 10-15 ml/kg Lactated Ringer's solution. Labor analgesia was maintained by intermittent boluses of the drug combination.Results:The mean time of the onset of analgesia was significantly lower (P<0.05) and the duration of analgesia was significantly higher (P<0.01) in Group B when compared with Groups A and C (P<0.001). Patient satisfaction was considerably better in Group B (P<0.01). However, in both groups, the progression of labor was found to be slightly more prolonged than Group C. The level of the sensory and motor block was comparable in both the groups and was at the T8–T10 level; it was comparable and the level of motor blockade (Bromage score = 0, 1) in each group was also not significant (P>0.05).Conclusion:The addition of fentanyl (2 μg/ml) to bupivacaine 0.125% decreases the time of the onset of analgesia and increases the duration of analgesia and level of maternal satisfaction during labor as compared to fentanyl (1 μg/ml).

Background and Aims:Sevoflurane, a popular inhalational anaesthetic for children, has been associated with significant emergence agitation in the recovery phase. This study was intended to compare two doses of caudal clonidine added to ropivacaine 0.2% in order to decide on the optimal dose for prevention of sevoflurane induced emergence agitation (EA) and to get a meaningful prolongation of postoperative analgesia with minimal side effects.Methods:Sixty-one children aged 1–7 years (American Society of Anaesthesiologists physical status I-II) received standardized general anaesthesia with inhaled sevoflurane and caudal epidural block with 0.2% ropivacaine 1 ml/kg for sub-umbilical surgeries. They were assigned randomly to two groups: (I) clonidine 1 μg/kg added to caudal ropivacaine; (II) clonidine 2 μg/kg added to caudal ropivacaine. EA and postoperative analgesia were assessed using pain/discomfort scale score and face, legs, activity, cry, consolability (FLACC) score respectively.Results:EA was observed in 8 children (26.6%) in group I when compared to only 2 children (6.4%) in group II after first 15 min postoperatively. Incidences of EA at 15 min, as well as total incidence of agitation, were both significantly lower in group II when compared to group I with P < 0.05. Duration of analgesia in group I (12 [8–20] h) and group II (16 [8–20] h) was statistically comparable (P > 0.05). There was no difference in the incidence of sedation or complications.Conclusion:Caudal clonidine 2 μg/kg added to 0.2% ropivacaine 1 ml/kg is suggested to be the optimal dose, for prevention of EA and meaningful prolongation of postoperative analgesia with minimal side-effects.

Background: Intermittent technique of labor epidural analgesia has been showing promising results over other techniques. This study was to assess and compare efficacy of two different doses of fentanyl mixed with low doses of bupivacaine in intermittent labor epidural analgesia.Methods: 90 ASA grade I-II parturients in active labor with a cervical dilatation of 3 to 5cm were randomly allocated to three different groups-Group A: 10ml Bupivacaine 0.125% + fentanyl 10µg (1µg/ ml).Group B: 10ml Bupivacaine 0.125% + fentanyl 20µg (2µg/ ml).Group C: 10ml Bupivacaine 0.125% (The control group).All patients were preloaded with 10-15ml/kg Lactated Ringer's solution. Labor analgesia was maintained by intermittent boluses of the drug combination. Results:The mean time of onset of analgesia was significantly lower (P<0.05) and the duration of analgesia was significantly higher (p<0.01) in Group B when compared with Group A and group C (p<0.001). The patients satisfaction was considerably better observed in Group B (p<0.01). However in both group's progression of labor was found to be slightly prolonged than group C. The level of sensory and the motor block was comparable in both the groups was at T8-T10 level and it was comparable and level of motor blockade (bromage score=0, 1) in each group was also not significant (p>0.05). Conclusion:Addition of fentanyl (2µg/ml) to bupivacaine 0.125% decreases the time of onset of analgesia and increases the duration of analgesia and level of maternal satisfaction during labor as compared to fentanyl (1µg).difficult and associated with an increased incidence of side effects like nausea, vomiting, pruritus along with use of opioids [4]. Although rarely with meningitis also been reported [5].The greatest advantage of implementing intermittent lumber epidural for labor analgesia is the lack of need of volume elastomeric epidural infusion pump; making its worth role in conducting deliveries in emergency settings, primary, secondary and tertiary health centres of developing countries (india etc.) where these facilities are not easily available but do have the human resources to provide the intermittent top-ups.Our study was designed to evolve a appropriate dose combination of bupivacaine and fentanyl in extradural labor analgesia using