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Initiating extradural analgesia during labour: comparison of three different bupivacaine concentrations used as the
C Harms1, M Siegemund, S C Marsch
1Department of Anaesthesia, University of Basel, Kantonsspital, Basel, Switzerland. harms@ubaclu.unibas.ch
Objective:
Potential effects of extradural analgesia on the progress of labour and obstetric outcome are still a matter of concern and the focus of ongoing debates. Despite this, little attention is paid to the initiation of extradural labour analgesia. The objective of this prospective, randomized, double-blind trial was to identify the optimal of three concentrations of bupivacaine used as a loading bolus for initiating extradural analgesia during labour.
Methods:
Sixty-seven full-term parturients requesting extradural analgesia received either bupivacaine 0.25% (group A), 0.125% (group B) or 0. 0625% (group C). Bupivacaine administration was titrated to achieve a pain score
Results:
The probability of obtaining a VAS pain score /=1 based on using a modified Bromage scoring scale. There were no differences in incidence of maternal hypotension, ephedrine requirements, foetal heart rate abnormalities, mode of delivery and neonatal outcome.
Conclusions:
Of the three concentrations used in this clinical setting, 0.125% was the most suitable concentration of plain bupivacaine to initiate extradural analgesia in labour. Using 0.25% bupivacaine increased the incidence of motor block, whereas for 0.0625% plain bupivacaine the probability to achieve adequate analgesia was unacceptably low.