Onset of labour epidural analgesia with low‐dose bupivacaine and different doses of fentanyl

• Published in: Anaesthesia 2017-11, Vol.72 (11), p.1371-1378
• Main Authors: Vedagiri Sai, R., Singh, S. I., Qasem, F., Nguyen, D., Dhir, S., Marmai, K., Adam, R., Jones, P. M.
• Format: Article
• Language: English
• Subjects: Adult; Analgesia; Analgesia, Epidural - methods; Analgesia, Obstetrical - methods; Anesthetics, Intravenous - administration & dosage; Anesthetics, Local; Apgar Score; Bupivacaine; Childbirth & labor; Contraction; Delivery contracts; Double-Blind Method; Drug therapy; epidural; Female; Fentanyl; Fentanyl - administration & dosage; Humans; Infant, Newborn; Labor, Obstetric; labour; Neonates; onset; Pain; Pain Measurement; Pain perception; Patient satisfaction; Patients; Pregnancy; Statistical analysis; Uterine Contraction; Uterus; Young Adult
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.14000

Summary This study investigated the effects of different doses of epidural fentanyl on the time to onset of epidural analgesia in women in early labour. We hypothesised that onset of epidural labour analgesia (the primary outcome defined as time in minutes from completion of epidural bolus to the first uterine contraction with a numeric pain rating scale [NPRS] score ≤ 3) would be faster with 100 μg of fentanyl epidural bolus compared with 20 μg or 50 μg. Epidural labour analgesia was initiated with 20 μg of fentanyl (F20 group), 50 μg (F50 group) or 100 μg (F100 group) along with 10 ml bupivacaine 0.08% as the loading dose. We randomly allocated 105 patients, with 35 patients in each group. Median (IQR [range]) time to achieve NPRS ≤ 3 was 18 (11–30 [6–20]) min in F20, 10 (8–19 [4–30]) min in F50 and 10 (6–16 [3–30]) min in F100 groups. There was a significant difference in onset times comparing F100 with F20 (p