Combined spinal epidural for labor analgesia comparison of two different doses of intrathecal bupivacaine 1.25 mg and fentanyl 25 µg with bupivacaine 2.5 mg and fentanyl 25 µg

Abstract

Background and Objective: The responsibility of the anesthetist in obstetrics is very high. This study compares two different low doses of intrathecal bupivacaine 1.25 mg and 2.5 mg along with 25 µg fentanyl as the spinal component of combined spinal epidural (CSE) analgesia in the early part of labor, followed by epidural top-up. Methodology: Approval was obtained from the institutional review board and written informed consent was obtained from 60 healthy term primigravida or the second gravid parturients, with cephalic singleton pregnancy between 36 and 42 weeks, ASA Grade I/II patients. The study was conducted using low-dose intrathecal bupivacaine 1.25 mg and fentanyl 25 µg (GroupI) with bupivacaine 2.5 mg and fentanyl 25 µg (Group II) as the spinal component of CSE analgesia in the early part of labor. We compared the two with respect to their onset, duration of sensory and motor block, quality of analgesia during early part of labor and the side effects of the drugs. Results: The onset of analgesia was equally rapid with both groups within 5 min, lower incidence of motor block with Group I compared to Group II. Duration of analgesia was longer in Group II, associated with higher dermatome levels of sensory block with longer time for regression of the block. Coclusion: We found that bupivacaine 1.25 mg was as effective as bupivacaine 2.5 mg when added to fentanyl 25 µg for CSE.