Continuous Epidural Infusion of 0.0625% Bupivacaine-0.0002% Fentanyl during the Second Stage of Labor

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A randomized, double-blind, placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor in nulliparous women. When the cervix was fully dilated, coded study solution was substituted for the known bupivacaine-fentanyl solution. The study solution for 29 patients was 0.0625% bupivacaine-0.0002% fentanyl; 34 patients received saline placebo. The two groups had similar pain scores during the first stage of labor. During the second stage, pain scores were significantly higher in the saline-placebo group at each 30-min interval between 60 and 150 min after the diagnosis of full cervical dilation. Similarly, there was a significant difference between the two groups in global assessment of analgesia quality during the second stage, but the difference occurred in those patients with a second-stage duration of ≥ 60 min. Among the women who delivered vaginally, eleven of 28 (39%) women in the bupivacaine-fentanyl group, versus five of 34 (15%) in the saline-placebo group, had surgical perineal anesthesia for vaginal delivery (P < .05). Six of 28 (21%) women in the bupivacaine-fentanyl group, and five of 34 (15%) in the saline-placebo group, underwent instrumental vaginal delivery (P = NS). The median duration of the second stage of labor was 53 min (range = 5–283) in the bupivacaine-fentanyl group, and 63 min (range = 16–181) in the saline-placebo group (P = NS). There were no significant differences between groups in Apgar scores or umbilical cord blood gas and acid-base values. The authors conclude that maintenance of an epidural infusion of 0.00625% bupivacaine/0.0002% fentanyl until delivery provided better second-stage analgesia than did replacement of the bupivacaine-fentanyl solution with saline placebo. Second, epidural infusion of bupivacaine-fentanyl until delivery did not significantly increase the incidence of instrumental delivery.

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