A double-blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labor analgesia

Abstract

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).

Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

“…There was no statistically significant difference between the two groups. Demographic and obstetric data were similar with the Indian studies by Kalra et al and Tomar et al 11,12 The baseline mean arterial blood pressure (MAP) and maternal heart rate (HR), VAS score were comparable in both the groups. For study purpose data were recorded for the first 60 minutes.…”

“…Tomar et al in a study using fentanyl 2 mcg/ml with bupivacaine 0.125% for epidural labour analgesia found the mean duration of first stage of labour to be 2.87 hours. 12 The mean duration of second stage of labour was 47.08 min in group F and 45.34 min in group T in this study. There was no statistically significant difference between the two groups.…”

“…Tomar et al and Fan et al studied the analgesic effects of fentanyl and tramadol in combination with bupivacaine and ropivacaine for extradural labour analgesia and found that the height level of sensory block was T8 in 16 and T10 level in 10 parturient. 12,13 In our study we used pinprick method to test the level of sensory blockade 54% in group F versus 56% in group T achieved the sensory level up to T10 which was comparable between the two groups.Motor block was assessed using a modified Bromage scale. All the parturient in both groups had grade 0 score.…”

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

“…Because single-dose local anesthetics offer pain relief of limited duration, adjuvants have been applied to prolong analgesia for peripheral nerve block. 18 – 20 Perineural dexamethasone can prolong the duration of local anesthetic blockade, 21 , 22 so we hypothesize that dexamethasone plus long-acting local ropivacaine for TPVB not only offers effective acute pain control with fewer side effects during the first 72 h after surgery but also reduces the incidence of CPTP.…”

Effect and safety of labor epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl on fetal and maternal outcomes and wellbeing

“…The addition of fentanyl (2 μg/ml) to bupivacaine 0.125% when used for labor epidural was found to decrease the time of onset of analgesia and increase the duration of analgesia and level of maternal satisfaction during labor as compared to fentanyl (1 μg/ml). [ 6 ] Epidural fentanyl up to 2.5 μg/mL administration does not usually result in either accumulation of the drug or subsequent neonatal respiratory depression. The Apgar score rates the five physical signs and is used to assess the condition of the infant at birth, but it is not specific for the effects of anesthesia on the newborn.…”