Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labour

Fernando, Roshan; Bonello, E.; Gill, Pamela J.; Urquhart, John; Reynolds, F.; Morgan, B.

doi:10.1111/j.1365-2044.1997.154-az0160.x

Cited by 61 publications

(23 citation statements)

References 41 publications

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“…When used during labor, similar concentrations were found in both maternal and cord blood (Fernando 1997). Also, fentanyl was less frequently associated with maternal nausea, vomiting or prolonged sedation than was pethidine (Rayburn 1989).…”

Section: Fentanyl Alfentanil Remifentanil and Sufentanil Pharmacolsupporting

confidence: 55%

Analgesics and anti-inflammatory drugs

Reuvers¹,

Schaefer²

2007

Drugs During Pregnancy and Lactation

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Section: Fentanyl Alfentanil Remifentanil and Sufentanil Pharmacolsupporting

confidence: 55%

Analgesics and anti-inflammatory drugs

Reuvers¹,

Schaefer²

2007

Drugs During Pregnancy and Lactation

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“…All parturients could feel the uterine contractions and psychological satisfaction of participating in the process of labour. Due to analgesic efficacy of fentanyl, the dose of bupivacaine was reduced thereby decreasing the maternal and foetal toxicity [7]. There was no incidence of hypotension, desaturation, motor or sensory block.…”

Section: Discussionmentioning

confidence: 99%

Walking Epidural : An Effective Method of Labour Pain Relief

Sharma

Setlur

Bhargava

et al. 2007

Medical Journal Armed Forces India

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Original ArticleIntroduction L abour and delivery results in severe pain for many women. The McGill Pain Questionnaire ranks labour pain in the upper part of the pain scale between cancer pain and amputation of a digit [1]. The goal of maternal labour analgesia is relief of pain without compromising maternal safety, progress of labour and foetal well-being. Epidural analgesia is the most effective and least depressant method of intrapartum pain relief in current practice [2]. Low concentration of bupivacaine combined with fentanyl, results in analgesia with minimal side effects [3]. The aim of the study, was to develop a safe dosing regime to provide satisfactory pain relief with minimal side effects. Material and MethodsIt was a prospective open label study. We studied 45 primiparous and five second gravida women with singleton foetus in vertex position admitted for parturition in the age group of 18-30 years. Parturients with obstetric complications like pre-eclampsia, preterm labour, previous caesarian, abnormal lie and placenta previa were excluded from the study. Once the parturient is in active phase of labour i.e. cervix is 3-4 cms dilated, anaesthesiologist was called for lumbar epidural block.After explaining the procedure, 500 ml of ringer lactate was infused as preload. Pre-epidural pulse, blood pressure (BP), SpO 2 and pain score (using Visual Analogue Scale-VAS) were checked. Foetal heart rate (FHR) was continuously monitored using cardiotocograph. All the parturient were kept fasting, but clear fluids were allowed till delivery. Epidural space was identified in L2-3 / L3-4 interspinous space using loss of resistance to saline and multiorifice epidural catheter inserted. Initial bolus of 10 ml of drug solution (0.1% bupivacaine and 0.0002% fentanyl) was injected in two aliquots, five ml in left lateral and five ml in right lateral position at an interval of five minutes. Maternal pulse, BP, SpO 2 and FHR were monitored every five minutes for the first 30 minutes. After 30 minutes pain score using VAS and motor blockade using modified Bromage Score (Table 1) was checked. If pain relief was satisfactory (VAS <5) and there were no motor block or evidence of significant hypotension an epidural infusion (with syringe infusion pump) of the same drug solution was started at the rate of 5ml /hour. Patient was assessed at 30 minutes interval for pain relief (objective assessment using VAS on 1-10 scale and subjective assessment by mother as excellent/good/fair/poor), maternal haemodynamics, foetal heart rate, motor block, duration of second stage of labour, incidence of caesarian section, instrumental delivery, side effects, complications (sedation, nausea, vomiting, itching, urinary retention) and total dose of bupivacaine and fentanyl used.

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“…The ability of the placenta to sequester large amounts of bupivacaine might expose the fetus to high concentrations of this anesthetic, even after the drug has disappeared from the maternal circulation. 10,17,18,20,21 Based on data in the literature regarding the placental transfer 6,10 -19 and the stereoselective kinetic disposition of bupivacaine in healthy volunteers, 1,2 the aim of the present investigation was to study the phenomenon of stereoselectivity in the maternal circulation and placental transfer of bupivacaine.…”

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confidence: 99%

Stereoselectivity in the placental transfer and kinetic disposition of racemic bupivacaine administered to parturients with or without a vasoconstrictor

et al. 2003

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The aim of the present study was to investigate the stereoselectivity in the kinetic disposition and the transplacental distribution of bupivacaine in term parturients during labor. Maternal age ranged from 18-37 years and fetal gestational age from 37.6-41.5 weeks. Healthy parturients (n = 23) received epidural 0.5% racemic bupivacaine alone (group A) or combined with epinephrine (group B). Maternal venous blood was sampled at regular intervals until 8 h after drug administration and umbilical venous blood was obtained at delivery. Bupivacaine enantiomers were determined in plasma samples by HPLC using a Chiralcel(R) OD-R column and a UV detector. One- or two-compartment models were fitted to data and differences between the (+)-(R) and (-)-(S) enantiomers were compared with the paired Wilcoxon test (P< 0.05). The influence of epinephrine was evaluated using the unpaired Mann-Whitney test (P< 0.05). The disposition of bupivacaine in maternal plasma was stereoselective, with higher V(d/f) (140.60 vs. 132.81 L for group A and 197.86 vs. 169.46 L for group B) and C(l/f) (29.00 vs. 25.43 L/h for group A and 33.15 vs. 26.39 L/h for group B) and lower t(1/2)beta (3.24 vs. 3.30 h for group A and 4.36 vs. 4.45 h for group B) being observed for (+)-(R)-bupivacaine. The combined administration of epinephrine resulted in higher V(d/f) (197.86 vs. 140.60 L for (+)-(R) and 169.46 vs. 132.81 L for (-)-(S)) and t(1/2)beta values (4.36 vs. 3.24 h for (+)-(R) and 4.45 vs. 3.30 h for (-)-(S)). The transplacental distribution of bupivacaine was stereoselective only when bupivacaine was administered without epinephrine (group B), with a higher cord blood/maternal blood ratio being observed for (-)-(S)-bupivacaine (0.40 vs. 0.35). Chirality 16:65-71, 2004.

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Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labour

Cited by 61 publications

References 41 publications

Analgesics and anti-inflammatory drugs

Analgesics and anti-inflammatory drugs

Walking Epidural : An Effective Method of Labour Pain Relief

Stereoselectivity in the placental transfer and kinetic disposition of racemic bupivacaine administered to parturients with or without a vasoconstrictor

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