A Randomized Controlled Comparison of Epidural Analgesia Onset Time and Adverse Reactions During Labor With Different Dose Combinations of Bupivacaine and Sufentanil

Abstract

Objectives: The purpose was to compare the effects of 3 different dose combinations of bupivacaine and sufentanil on the onset of analgesia and the occurrence of side effects. Materials and Methods: One hundred sixty-nine pregnant women were randomly assigned to 3 groups: the B1S5 group received 0.1% bupivacaine+5 μg sufentanil in 15 mL; the B125S5 group received 0.125% bupivacaine+5 μg sufentanil in 15 mL; and the B1S10 group received 0.1% bupivacaine+10 μg sufentanil in 15 mL. The primary outcome was the analgesic onset time, and the secondary outcomes were mode of delivery, patient satisfaction, maternal and neonatal side effects (pruritus, hypotension, sedation, motor block, decreased fetal heart rate, fever, and interference with breastfeeding). Results: The median (inter-quartile range) time to achieve effective analgesia was significantly faster in the B125S5 group than in the B1S5 group (10 [11-14 {4-30}] min vs. 15 [17-20 {5-30}] min, P<0.001). There was no significant difference in the analgesia onset time between the B1S10 and B125S5 groups (10 [11-14 {4-30}] min vs. 12 [13-15 {3-30}] min, P=0.202). Pruritus, hypotension, motor block, maternal satisfaction, delivery mode, decreased fetal heart rate, total bupivacaine dose and breastfeeding scores were not significantly different among the 3 groups except the sufentanil dosage and incidence of mild drowsiness and fever (the B1S10 group had significantly higher fever than the other groups). Discussion: The B125S5 combination may be superior to the B1S5 and B1S10 combinations as an initial dose for epidural analgesia to achieve rapid effective analgesia with minimal side effects.

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

“…We chose an epidural loading dose of approximately 15 mL in all patients according to previous reports of EA, consisting of 6-7.5 mL of lidocaine or chloroprocaine followed by 8 mL of PIEB solution. 2,4 A lidocaine concentration of 1% was chosen according to a report by Shahram Nafisi. 20 Based on preliminary findings and reports in the literature, 6 mL of 1.5% and 7.5 mL of 1.2% chloroprocaine were the volumes and concentrations selected to explore an optimal volume and concentration with an equal total dosage (9 mg).…”

“…The primary outcome was the analgesia onset time, which was defined as the time from the end of the administration of the initial dose to adequate analgesia. 4 Parturients were asked to indicate their level of pain based on a score ranging from 0 (no pain) to 10 (worst imaginable pain). After neuraxial analgesia had been completed, the visual analog scale (VAS) score was measured in a blinded manner during each active uterine contraction.…”

“…The mean EA onset time (time from the initial bolus to VAS score≤3) is approximately 15 min, which is significantly longer than that obtained with the combined spinal-epidural (CSE) technique and dural puncture epidural (DPE) technique. 4 Chloroprocaine is a local ester anesthetic that is approved by the US Food and Drug Administration (FDA) for neuraxial analgesia due to its rapid onset and short duration. 5 In recent years, chloroprocaine has been reintroduced into clinical practice and is widely used in emergency lower abdominal surgery and ambulatory lower limb surgery via epidural or spinal access.…”

Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis

“…An additional four records were identified by searching the grey literature, and one final record was obtained by correspondence with a trial author (P. Steer, personal communication, 2021). Thus, a total of 42 records 11 , 12 , 13 , 14 , 15 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 – representing 34 studies and including a total 10 221 participants – are included in the review.…”

“…The comparator in 24 of the 34 studies was an active control arm. This was either a different dose, 56 , 67 , 84 drug, 54 , 57 , 60 , 64 , 65 , 69 , 78 , 79 or administration process 11 , 12 , 52 , 59 , 61 , 66 , 68 , 71 , 75 , 82 to the trial intervention. In four trials all participants received the same epidural analgesia and an additional trial intervention that had no active comparator.…”