Article révisé par les pairs
Résumé : Introduction: Combined Spinal Epidural technique is widely used in labour analgesia. It allows to start analgesia of the first stage of labour with low doses of local anesthetics or opiolds or a combination of both. Different regimens are used in the littérature. We performed a study to evaluate the best combination of intrathecal local anesthetics, epinephrin and opiolds in terms of duration of analgesia and pruritus. Methods: We randomized 72 labouring parturients requesting perimedullar analgesia in three groups. The first group ( I ) received 1.25mg plain bupivacaln with 25ug epinephrin and 25 g fentanyl. The secound group ( II ) received 2.5mg plain bupivacata with SOug epinephrin and 25ug fentanyl. The third group ( III ) received 1.25mg plain bupivacaln with 25jag epinephrin and Sug sufentanil. All solutions were given in a 2ml volume. We studied obstetric an demographic data along with duration of initial dose ( injection to next request ) and with incidence and severity of pruritus. Results: The three groups were obstetrically and demographically comparable. Mean durations of analgesia were not significantly different: 119.6 +/- 47.6 min. in group I, 127 +/- 24 min. in group II, 145 +/- 55.9 min. in group III. Incidence of pruritus in group I compared with group III was highly significant: 28 % and 77 % (P< 0.01); when we compared group I with group II, the difference was almost significant: 28% vs 54 % ( P= 0.06 ); when we compared group II with group III, the difference was not significant: 54 % vs 77 %. Pruritus was mild in all cases and did not require any treatment. Conclusion: Mean durations of analgesia were not significantly different. Using twice the dose of bupivacaln as in group II compared with group I did not prolong mean duration of analgesia. The addition of epinephrin did not have a positive effect on mean duration. Increasing the dose of epinephrin twofold seemed to increase the incidence of pruritus in group II (P=0.06). Sufentanil did not prolong analgesia compared to fentanyl but had a significantly higher pruritus rate (group I compared with group III). We conclude that, when using a combination of local anesthetics and opiolds to provide spinal analgesia in the first stage of labour, low doses of bupivacaln (11.25mg) with fentanyl and low dose epinephrin (2Sug) seems to achieve the lowest rate of secoundary effects while achieving equivalent duration of analgesia.