Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study

AbstractWe retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased incidence of adverse fetal heart rate changes.Some 520 cardiotocographic tracings were examined for changes in fetal heart rate and uterine activity following two different protocols of combined spinal epidural analgesia. Charts were consulted for neonatal and labor outcome.When sufentanil was used epidurally instead of intrathecally, the incidence of adverse changes in fetal heart trace was less, demonstrated by a higher percentage of normal reassuring tracings (74.5% vs. 60.4% when sufentanil was used intrathecally; P=0.007), less tracings showing bradycardia (7.5% vs. 14.1%; P=0.035), and more tracings displaying 3 or more accelerations in fetal heart rate in 45 min (93.5% vs. 83.9%; P=0.003) together with less episodes of tachycardia (3.5% vs. 11.4%; P=0.005). There were no differences in labor and neonatal outcome.Based on fetal heart tracing, it seems favorable to ban sufentanil from the intrathecal compartment.

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Comparison of epidural analgesia with combined spinal-epidural analgesia for advanced labour: a retrospective study of 1 year

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00524 ◽

2014 ◽

Vol 31 ◽

pp. 184-185

Author(s):

G. Maggi ◽

E. Guasch ◽

Kollmann A. Camaiora ◽

R. Schiraldi ◽

B. Nicolas ◽

...

Keyword(s):

Retrospective Study ◽

Epidural Analgesia ◽

Combined Spinal Epidural ◽

Spinal Epidural

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Chronobiology of Subarachnoid Fentanyl for Labor Analgesia

Anesthesiology ◽

10.1097/00000542-200509000-00023 ◽

2005 ◽

Vol 103 (3) ◽

pp. 595-599 ◽

Cited By ~ 18

Author(s):

Peter H. Pan ◽

Sherman Lee ◽

Lynne Harris

Keyword(s):

Epidural Analgesia ◽

Pain Scale ◽

Labor Analgesia ◽

Patient Demographics ◽

Combined Spinal Epidural ◽

Institutional Review ◽

Nulliparous Women ◽

Scale Scores ◽

Administration Time ◽

Spinal Epidural

Background Chronobiology studies the recurrent biologic rhythms that directly affect how an organism interacts with its environment and how its environment affects the organism. The purpose of this study is to determine whether the time of administration influences the analgesic duration of the commonly used subarachnoid fentanyl for labor analgesia. Methods After institutional review board approval and informed consent were obtained, 77 healthy nulliparous women in active labor requesting neuraxial analgesia were assigned to one of two groups, based on the time of combined spinal-epidural analgesia placement: the day group, for the time period from 12:00 to 18:00, and the night group, for the period from 20:00 to 02:00. Combined spinal-epidural analgesia was performed with 20 microg subarachnoid fentanyl. An epidural catheter was inserted but not dosed until patients requested further analgesia. Dynamic data were recorded at 5-min intervals for 20 min initially and then every 15 min. The analgesic duration was defined as the time from subarachnoid fentanyl injection to the time the patient requested further analgesia. Results Seventy evaluable patients completed the study, with 35 per group. Patient demographics, visual analog pain scale scores, and labor characteristics were similar between groups, but the duration (mean +/- SD) for subarachnoid fentanyl labor analgesia was 92 +/- 34 min for the day group and 67 +/- 21 min for the night group (P < 0.001). Conclusions The results indicate that chronobiology of subarachnoid fentanyl plays a significant role of up to 27% difference in labor analgesic duration between the two administration time periods studied. Chronobiology should be incorporated in future comparative studies or analysis of previous studies on subarachnoid fentanyl.

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Epidural Analgesia Compared with Combined Spinal–Epidural Analgesia during Labor in Nulliparous Women

New England Journal of Medicine ◽

10.1056/nejm199712113372402 ◽

1997 ◽

Vol 337 (24) ◽

pp. 1715-1719 ◽

Cited By ~ 141

Author(s):

Michael P. Nageotte ◽

David Larson ◽

Pamela J. Rumney ◽

Mohan Sidhu ◽

Katherine Hollenbach

Keyword(s):

Epidural Analgesia ◽

Combined Spinal Epidural ◽

Nulliparous Women ◽

Spinal Epidural

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A Randomized Study of Combined Spinal-Epidural Analgesia versus Intravenous Meperidine during Labor

Anesthesiology ◽

10.1097/00000542-199812000-00010 ◽

1998 ◽

Vol 89 (6) ◽

pp. 1336-1344 ◽

Cited By ~ 100

Author(s):

David R. Gambling ◽

Shiv K. Sharma ◽

Susan M. Ramin ◽

Michael J. Lucas ◽

Kenneth J. Leveno ◽

...

Keyword(s):

Epidural Analgesia ◽

Cesarean Delivery ◽

Local Anesthetics ◽

Full Term ◽

Operative Delivery ◽

Fetal Bradycardia ◽

Combined Spinal Epidural ◽

Nulliparous Women ◽

Emergency Cesarean ◽

Spinal Epidural

Background Combined spinal-epidural (CSE) analgesia produces rapid-onset pain relief and allows ambulation in early labor. Epidural local anesthetics may contribute to an increase in operative deliveries by decreasing perineal sensation and causing motor weakness. Operative delivery rates might be reduced with CSE, by avoiding or delaying administration of local anesthetics. This study compares the operative delivery rates associated with a CSE technique and those associated with intravenous meperidine for labor analgesia. Methods Healthy parturients at full term were assigned randomly to receive CSE or intravenous meperidine analgesia. The CSE group received 10 microg intrathecal sufentanil, followed by epidural bupivacaine and fentanyl at their next request for analgesia. Parturients receiving intravenous meperidine had 50 mg on demand (maximum, 200 mg in 4 h). Labor and delivery outcomes in both groups were recorded and compared. Results An intent-to-treat analysis of 1,223 women indicated that CSE does not increase the rate of cesarean delivery for dystocia in nulliparous and parous women (CSE, 3.5% vs. intravenous meperidine, 4; P=not significant) or in nulliparous women alone (CSE, 7% vs. intravenous meperidine, 8%; P=not significant). Profound fetal bradycardia that necessitated emergency cesarean delivery within 1 h of the time the mother received sufentanil occurred in 8 of 400 parturients (compared with 0 of 352 who received meperidine; P < 0.01). However, the method of fetal monitoring differed between the two groups. Despite this, neonatal outcomes were similar overall. Conclusions Combined spinal-epidural analgesia during labor does not increase the cesarean delivery rate for dystocia in healthy parturient patients at full term, regardless of parity. However, an unexpected increase in the number of cesarean deliveries for profound fetal bradycardia after intrathecal sufentanil was observed. Further investigation is warranted.

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