Epidural bupivacaine-pethidine mixture clinical experience using a low-dose combination in labour

In an attempt to overcome some of the undesirable side-effects and sequelae traditionally associated with epidural analgesia, various mixtures containing bupivacaine and pethidine have been examined during labour. Preliminary investigations suggested that a mixture containing bupivacaine 0.125% was the most promising combination, and accordingly a prospective survey was conducted in order to assess this mixture further; 100 mothers were included in the survey and clinical assessment included analgesic efficacy, side-effects, degree of mobility, obstetric outcome and patient satisfaction. Ninety per cent of mothers described their pain relief as satisfactory following the initial dose and 67% chose to receive this mixture alone throughout labour. Among those who delivered vaginally, delivery occurred spontaneously in 63% of primiparas and 90% of multiparas. Urinary catheterization was required in only 10% of spontaneous deliveries. Mean umbilical vein blood concentrations at birth among 48 neonates were 0.12 mg/L and 0.05 mg/L respectively for pethidine and bupivacaine. Despite, in some cases, recall of severe pain at delivery patient satisfaction was extremely high. Reasons given for this high approval rating included the quality of analgesia, mood elevation, mobility, and feeling aware or in control during labour.