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Two doses of intrathecal sufentanil (2.5 and 5 μg) combined with bupivacaine and epinephrine for labor analgesia

par Mardirosoff, Chahé;Dumont, Lionel
Référence Anesthesia and analgesia, 89, 5, page (1263-1266)
Publication Publié, 1999

Article révisé par les pairs

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Résumé :

In this study, we evaluated the effect of two doses of intrathecal sufentanil combined with bupivacaine and epinephrine on the incidence of pruritus and on the duration and quality of analgesia. One hundred five parturients were enrolled in this randomized, double-blinded, placebo- controlled study. They received either intrathecal 1.25 mg bupivacaine and 25 μg epinephrine (control group); 1.25 mg bupivacaine, 25 μg epinephrine, and 2.5 μg sufentanil (2.5-μg group); or 1.25 mg bupivacaine, 25 μg epinephrine, and 5 μg (5-μg group). Pain relief was assessed 10 min after injection, and pruritus was recorded at 30 min by a blinded observer. The study ended when the parturients requested further analgesia. There were no demographic differences among groups. Ninety of 103 parturients achieved complete pain relief with the initial dose, 11 patients in the control group (P < 0.004, control versus both sufentanil groups), and 2 patients in the 2.5-μg group needed a supplemental epidural bupivacaine. Pruritus was absent in the control group (P < 0.0001, control versus both sufentanil groups), whereas it was present in 36% of the 2.5-μg group and in 66% of the 5-μg group (P = 0.015, 2.5-μg versus 5-μg group). The mean duration of analgesia was similar in patients receiving sufentanil (2.5-μg group: 133 ± 55 min; 5-μg group: 142 ± 52 min) but was significantly higher than the control group (56 ± 32 min). Reducing the sufentanil dose from 5 μg to 2.5 μg when combined with bupivacaine and epinephrine, decreases the incidence of pruritus without impeding the quality or duration of analgesia. Implications: We evaluated two different doses of intrathecal sufentanil combined with bupivacaine and epinephrine for labor analgesia. Sufentanil 2.5 μg offered an advantage over sufentanil 5 μg because, while providing the same quality and duration of analgesia, it was associated with a reduced incidence of pruritus.