Combined Spinal-Epidural Analgesia and Epidural Analgesia in Labor: Effect of Intrathecal Fentanyl vs. Epidural Bupivacaine as a Bolus
Pornswan Ngamprasertwong MD*, Kanya Kumwilaisak MD*, Toonchai Indrambarya MD*, Kaew Supbornsug MD*, Suchera Ngarmukos MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
Objective : To compare the clinical effects of intrathecal fentanyl with conventional epidural bupivacaine
bolus before the same continuous epidural infusion for labor analgesia.
Materials and Methods : Fifty parturients in active labor were randomized to receive subarachnoid fentanyl 25
mcg as part of a combined spinal epidural analgesia (CSE) or bupivacaine 0.25% 10 ml incrementally into
the epidural space in the epidural group. After that, 0.0625% bupivacaine with fentanyl 2 mcg/ml was infused
via epidural catheter in all women at a rate of 12 ml/h. Verbal numeric pain scores (VNPS), onset time to pain
relief, times of additional analgesia and other side effects were recorded.
Results : Mean (SD) onset time to the first pain free contraction was not significantly different (7.8 + 4.3 min
in the CSE group, 10.2 + 5.1 min in epidural group, p = 0.085). Most of the patients in the CSE group required
additional epidural bolus dose (80% compared to 48% in the Epidural group, p = 0.038). There was no
difference in motor blockage at time of delivery or mode of delivery. Significantly more women in the CSE
group had pruritus (68%VS none in the epidural group, p < 0.001), all had mild degree and did not require
any treatment. There was no difference in other side effects.
Conclusion : Intrathecal fentanyl as part of CSE did not produce statistically a significant faster onset com-
pared to epidural bupivacaine bolus. Most of the patients in the CSE group required epidural bolus after
intrathecal fentanyl with a higher incidence of pruritus.
Keywords : Combined spinal epidural analgesia, CSE, Epidural analgesia, Labor, Obstetric
