Intrathecal opioids plus bupivacaine: an option to prolong analgesic efficacy when using the combined spinal-epidural...

Providing analgesia in the latent phase of labor can be challenging. Many obstetricians and nurse midwives believe that epidural analgesia initiated too early in the course of labor can prolong labor and result in fetal malpresentation, thus increasing the need for instrumentation. Many practitioners therefore use the combined spinal-epidural technique with intrathecal opioids during the early portion of first stage labor and initiate epidural analgesia only in the active phase of labor. However, the use of intrathecal opioids has been shown to be less than efficacious in meeting the analgesic needs in a large segment of the patient population, thus requiring initiation of epidural analgesia after only 1 to 2 hours. A case is reported in which the combined spinal-epidural technique was utilized in a primigravida patient. An intrathecal dose of 15 micrograms of sufentanil was given with a dilute concentration of bupivacaine at the initiation of analgesia. Analgesia was provided for approximately 5 hours before epidural analgesia was required. The patient delivered by spontaneous vaginal delivery without instrumentation or adverse sequelae to mother or infant.