J Korean Med Sci.  2010 Feb;25(2):287-292. 10.3346/jkms.2010.25.2.287.

Effects of Epidural Fentanyl on Speed and Quality of Block for Emergency Cesarean Section in Extending Continuous Epidural Labor Analgesia Using Ropivacaine and Fentanyl

• Hong JY
• Jee YS
• Jeong HJ
• Song Y
• Kil HK

• KMID: 1779262
• DOI: http://doi.org/10.3346/jkms.2010.25.2.287

Abstract

We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microgram fentanyl/epinephrine (n=31) and 2% lidocaine/saline/epinephrine (n=30) when extending an epidural labor analgesia using low-dose ropivacaine and fentanyl. Survival analysis for the sensory blocks to the T4 level showed no statistically significant differences in onset time to T4 between the 2 groups. Onset times (min) to T4-sensory blocks for cold and pinprick were not different between the two groups. However, median maximum sensory level in the lidocaine-fentanyl group (T1 for cold and T2 for pinprick) was significantly higher than that in the lidocaine-saline group (T3 and T4, respectively). The lidocaine-fentanyl group exhibited less visceral pain (6.5% vs. 36.7%), less supplementation of lidocaine (6.5% vs. 43.3%), and less nausea (6.5% vs. 26.7%) compared with the lidocaine-saline group during the intraoperative period. It is concluded that adding fentanyl to 2% lidocaine does not speed up the onset of the block when the onset is tested with cold or sharp pinprick but improves the quality of analgesia with fewer side effects in emergency top-up for cesarean section.

Keyword

Cesarean Section; Epidural Fentanyl; Labor Analgesia

MeSH Terms

Adult
Amides/*administration & dosage
*Analgesia, Epidural
Analgesics, Opioid/*administration & dosage
Anesthetics, Local/*administration & dosage
*Cesarean Section
Double-Blind Method
Emergency Medical Services
Epinephrine/administration & dosage
Female
Fentanyl/*administration & dosage
Humans
Lidocaine/administration & dosage
Pain Measurement
Pain, Postoperative/etiology
Pregnancy
Prospective Studies
Vasoconstrictor Agents/administration & dosage
Amides
Analgesics, Opioid
Anesthetics, Local
Vasoconstrictor Agents
Lidocaine
Fentanyl
Epinephrine

Figure

• 

  Fig. 1 (A) Kaplan-Meier survival curves for sensory block of cold and pinprick to T4 following the epidural top-ups with lidocaine 2%-fentanyl 100 µg-epinephrine 1:200,000 (lidocaine-fentanyl group) or lidocaine 2%-normal saline 2 mL-epinephrine (lidocaine-saline group). (B) Range (whiskers), interquartile range (boxes), median (thin vertical bars), and mean (thick vertical bars) for sensory block of cold and pinprick to T4. There are no statistical differences in onset time to T4 for cold sensation (P=0.102) and pinprick (P=0.053) between the 2 groups.

• 

  Fig. 2 Postoperative pain scores (VAS) during 48 hr were similar. Data are shown in box plot with ranges (whiskers), interquatile ranges (boxes), median (solid line), and mean (bold line). Lidocaine-fentanyl group, epidural top-up with lidocaine 2%-fentanyl 100 µg-epinephrine 1:200,000; lidocaine-saline group, epidural top-up with lidocaine 2%-normal saline 2 mL-epinephrine 1:200,000.

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