Intrathecal sufentanil compared to epidural bupivacaine for labor analgesia

Although intrathecal sufentanil has been reported to provide rapid-onset, complete analgesia lasting 1-3 h for the first stage of labor, no well-controlled double-blind study has compared this technique to the use of epidurally administered local anesthetics.

Fifty healthy parturient women requesting labor analgesia were studied. In a combined spinal-epidural technique, a spinal needle was inserted through the epidural needle before insertion of the epidural catheter. Patients were randomly assigned to receive either intrathecal sufentanil (10 micrograms) and epidural saline, or intrathecal saline and epidural bupivacaine (30 mg). Visual analog scores for pain, blood pressure, heart rate, sensory levels, and the incidence of nausea, pruritus, and motor blockade were recorded.

Patients receiving intrathecal sufentanil had significantly lower visual analog pain scores at 5, 15, and 30 min after injection and a greater duration of analgesia before requesting additional medication (mean 123 vs. 68 min for those receiving bupivacaine; P < 0.05). These patients also experienced pruritus more frequently but motor blockade less frequently than patients receiving epidural bupivacaine. The groups exhibited dermatomal sensory deficits to pin prick as well as bradycardia and hypotension with equal frequency. The length of labor and type of delivery were similar between the groups. No patient experienced a post-dural puncture headache.

The rapid onset of analgesia and lack of motor blockade from intrathecal sufentanil injection may be advantageous in certain clinical situations. With this technique, however, pruritus is common; hypotension may occur; and extensive dermatomal spread suggests that early-onset respiratory depression could occur. Therefore, blood pressure and respiratory adequacy should be monitored if intrathecal sufentanil is used.