Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?

Autor:	V. Sodhi, R. Fernando, Gordon Lyons, Sarah Armstrong, N. P. Patel, Malachy O. Columb, J. K. Bray
Rok vydání:	2012
Předmět:	Bupivacaine medicine.medical_specialty business.industry Analgesic Intrathecal Surgery Fentanyl Labour analgesia Anesthesiology and Pain Medicine Opioid Anesthesia Heart rate medicine Ephedrine business medicine.drug
Zdroj:	Anaesthesia. 67:584-593
ISSN:	0003-2409
DOI:	10.1111/j.1365-2044.2011.07045.x
Popis:	Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 μg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 μg. Analgesia was assessed using a visual analogue pain score. When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::6d979ca82cc1c66a67fec708027af585 https://doi.org/10.1111/j.1365-2044.2011.07045.x Zobrazit plný text záznamu Plný text