0.0625-PERCENT BUPIVACAINE WITH 0.0002-PERCENT FENTANYL VIA PATIENT-CONTROLLED EPIDURAL ANALGESIA FOR PAIN OF LABOR AND DELIVERY

Objective: To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery. Design and Subjects: Forty-one women in established labor were randomized to receive either (a) 0.0625% bupivacaine with 2 mu g/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background infusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 mu g/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Supplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., x3) was administered for treatment of breakthrough pain upon patient request. The study protocol was double-blind and placebo-controlled. Outcome Measures: Visual analogue pain scores, motor strength, pinprick level of sensory analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular study group. Results: The cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual analogue pain scores, intensity of motor blockade, and need for physician-administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achieving analgesia comparable to patients receiving CEI. Conclusions: The results of this study show that 0.0625% bupivacaine with 2 mu g/ml of fentanyl is an effective analgesic combination when used via PCEA.