Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial (original) (raw)

2017, SOJ Pharmacy & Pharmaceutical Sciences

Background: Combined spinal epidural analgesia (CSEA) has become a widespread technique in obstetric analgesia. Sufentanil is currently widely used in combination with a low concentration of local anaesthetic to reduce both motor block and local anesthetic requirements. While some studies have reported on the hemodinamic changes after the intrathecal administration of sufentanil in the early phase of labor, no randomized controlled trials have been performed. We compared hemodynamic impact, quality of the analgesia, safety, side effects and impact on labor and delivery after the administration of two equipotent doses of sufentanil given by intrathecal versus epidural route. Methods: Nulliparous parturients with full-term uncomplicated pregnancies, in established first stage of labor and requesting analgesia were enrolled into this randomised-controlled, single blind, parallel study. Patients were equally randomised to receive either epidural (EA) (sufentanil 1,4 mcg ml-1-15ml) or CSEA(sufentanil 2,5 mcg/4 ml). At the reappearance of pain, analgesia was continued in both groups with the same protocol of epidural boluses of levobupivacaine + sufentanil. Results: Seventy parturients were enrolled in the study (35 for each group). There was a minimal and non statistically significant decrease from the baseline systolic arterial pressure (127,9±14,6 mmHg in EA and 124,6±28,3 mmHg in CSEA) with no differences between the two groups (125,9+15,54 mmHg in EA and 122±14,62 mmHg in CSEA). In both groups we observed a reduction of NRS mean values at 15 minutes (p<0,05) that was lower in CSEA group (3,2±2,4 vs 5,1±2,2 in EA group). Pruritus was more common in CSEA while the total time for dilatation, duration of the expulsive period, delivery type, rates of instrumental deliveryand foetal heart rate abnormalities were similar in both groups Conclusions: This study was unable to demonstrate any difference in the hemodynamic effects of neuraxial analgesia with sufentanil in the early phase of labor when the intrathecal ED50 and the epidural ED50 were compared. Better and faster levels of analgesia may be achieved with CSEA.