A randomised double-blind comparison of epidural fentanyl versus fentanyl and bupivicaine for pain relief in the second stage of labour

BJOG : an International Journal of Obstetrics and Gynaecology
S W LindowI F Russell

Abstract

To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour-fentanyl alone versus the usual mixture of bupivicaine and fentanyl. A double-blind, randomised, controlled trial. An English maternity hospital. Eighty nulliparous women in the second stage of labour. After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl-only solution given at the same rate. Mode of delivery, duration of the second stage and quality of analgesia. There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02-1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3-1.0). Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.

References

May 1, 1991·Anesthesiology·D H Chestnut
Oct 1, 1983·Anaesthesia·K C Phillips, T A Thomas
Mar 1, 1983·British Journal of Obstetrics and Gynaecology·C F GoodfellowR M Buijs
Jul 17, 2001·Lancet·UNKNOWN Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK

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Citations

May 19, 2005·Obstetrics and Gynecology Clinics of North America·Amen NessVincenzo Berghella

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