Biomaterial Database

Spinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia. 1996

L Kartawiadi, and M P Vercauteren, and A L Van Steenberge, and H A Adriaensen

Department of Anesthesiology, University Hospital Antwerp, Belgium.

OBJECTIVE The purpose of this investigation was to evaluate the effectiveness and side effects of combined spinal-epidural (CSE) injection of a bupiv-acaine-sufentanil-epinephrine mixture during labor as compared with epidural analgesia alone. METHODS In a randomized trial, 63 parturients presenting for vaginal delivery received either epidural analgesia (10 mL) with 12.5 mg bupivacaine plus 10 micrograms sufentanil and 12.5 micrograms epinephrine or CSE analgesia with a single subarachnoid injection of 1 mg bupivacaine plus 5 micrograms sufentanil and 25 micrograms epinephrine (total volume, 2.5 mL). For this purpose a 29-gauge BD-Quincke spinal needle was used. All subsequent top-ups consisted of 10 mL of the mixture, as used for the patients who received epidural analgesia only. RESULTS Thirteen patients delivered without requesting a second injection. The time required to obtain satisfactory analgesia (visual analog score < or = 2.5 and/or > 50% improvement) was significantly shorter for those who received the subarachnoid mixture than for the epidural analgesia group (4.0 +/- 0.4 vs 10.4 +/- 0.5 minutes, respectively, P < .001). The duration of analgesia was longer for the CSE group (137.4 +/- 11.5 vs 106.4 +/- 11.8 minutes, P < .05), with more patients being pain-free for longer than 150 minutes (40 vs 8%, P < .05). Less bupivacaine was consumed in the group receiving the subarachnoid mixture (21.6 +/- 2.0 vs 30.7 +/- 2.1 mg, P < .01). Pruritus was more common following subarachnoid than following epidural injection of sufentanil (53.1 vs 25.8%, P < .05). Other side effects related to the injected drugs, such as motor impairment, hypotension, or nausea or vomiting, were not observed. Although all blocks were uneventful, moderate headache compatible with postdural puncture headache occurred in two patients of the CSE group, which necessitated a blood patch after 5 days. CONCLUSIONS The CSE mixture induced long-lasting analgesia, with fast onset and without motor block or hypotension. Pruritus and headache were the major drawbacks of this technique.

UI	MeSH Term	Description	Entries
D002045	Bupivacaine	A widely used local anesthetic agent.	1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide,Bupivacain Janapharm,Bupivacain-RPR,Bupivacaina Braun,Bupivacaine Anhydrous,Bupivacaine Carbonate,Bupivacaine Hydrochloride,Bupivacaine Monohydrochloride, Monohydrate,Buvacaina,Carbostesin,Dolanaest,Marcain,Marcaine,Sensorcaine,Svedocain Sin Vasoconstr,Bupivacain RPR
D004837	Epinephrine	The active sympathomimetic hormone from the ADRENAL MEDULLA. It stimulates both the alpha- and beta- adrenergic systems, causes systemic VASOCONSTRICTION and gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels. It is used in ASTHMA and CARDIAC FAILURE and to delay absorption of local ANESTHETICS.	Adrenaline,4-(1-Hydroxy-2-(methylamino)ethyl)-1,2-benzenediol,Adrenaline Acid Tartrate,Adrenaline Bitartrate,Adrenaline Hydrochloride,Epifrin,Epinephrine Acetate,Epinephrine Bitartrate,Epinephrine Hydrochloride,Epinephrine Hydrogen Tartrate,Epitrate,Lyophrin,Medihaler-Epi,Acetate, Epinephrine
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults
D000701	Analgesics, Opioid	Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS.	Opioid,Opioid Analgesic,Opioid Analgesics,Opioids,Full Opioid Agonists,Opioid Full Agonists,Opioid Mixed Agonist-Antagonists,Opioid Partial Agonists,Partial Opioid Agonists,Agonist-Antagonists, Opioid Mixed,Agonists, Full Opioid,Agonists, Opioid Full,Agonists, Opioid Partial,Agonists, Partial Opioid,Analgesic, Opioid,Full Agonists, Opioid,Mixed Agonist-Antagonists, Opioid,Opioid Agonists, Full,Opioid Agonists, Partial,Opioid Mixed Agonist Antagonists,Partial Agonists, Opioid
D000775	Anesthesia, Spinal	Procedure in which an anesthetic is injected directly into the spinal cord.	Anesthesias, Spinal,Spinal Anesthesia,Spinal Anesthesias
D000779	Anesthetics, Local	Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate.	Anesthetics, Conduction-Blocking,Conduction-Blocking Anesthetics,Local Anesthetic,Anesthetics, Topical,Anesthetic, Local,Anesthetics, Conduction Blocking,Conduction Blocking Anesthetics,Local Anesthetics,Topical Anesthetics
D015360	Analgesia, Epidural	The relief of pain without loss of consciousness through the introduction of an analgesic agent into the epidural space of the vertebral canal. It is differentiated from ANESTHESIA, EPIDURAL which refers to the state of insensitivity to sensation.	Epidural Analgesia
D016362	Analgesia, Obstetrical	The elimination of PAIN, without the loss of CONSCIOUSNESS, during OBSTETRIC LABOR; OBSTETRIC DELIVERY; or the POSTPARTUM PERIOD, usually through the administration of ANALGESICS.	Obstetrical Analgesia,Analgesia, Obstetric,Obstetric Analgesia
D017409	Sufentanil	An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent.	R-30730,Sufenta,Sufentanil Citrate,Sufentanil Curasan,Sufentanil-Hameln,Sufentanil-Ratiopharm,Sulfentanil,Sulfentanyl,Citrate, Sufentanil,Curasan, Sufentanil,R 30730,R30730,Sufentanil Hameln,Sufentanil Ratiopharm,SufentanilHameln,SufentanilRatiopharm