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| |  Timing May Impact Neonatal Fentanyl Levels During Labour and Delivery: Presented at ASA By Arushi Sinha, PhD SAN FRANCISO, CA -- October 23, 2007 -- Use of epidural alone during labour carries a lower risk of motor blockade in the legs and a reduced risk of foetal bradycardia at first dose, according to research presented here at the Annual Meeting of the American Society of Anesthesiologists (ASA). One of the major concerns surrounding pregnancy is the effect of analgesics and pain medications on the health of the newborn. According to research, there is a need to better understand the efficacy of traditional epidurals when compared with combined spinal epidurals (CSE). Virendra Arya, MD, Associate Professor, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India, and his colleagues, designed a study to examine such outcomes. The study enrolled 408 women in early active labour who were randomly assigned to one of two intervention regimens. The first group of 210 women received an epidural dose of 10-ml mixture of 0.15% bupivacaine and 40 µg fentanyl; the second group of 198 women received a CSE dose of 1-mL mixture of 2.5 mg hyperbaric bupivacaine and 25 mcg fentanyl. If pain persisted, the patient received 10-mL epidural top-up of up to 0.15% bupivacaine combined with 2 mcg/mL fentanyl, as requested. A sampling of umbilical venous blood (UVB) was taken at the time of delivery to test for fentanyl levels, and neonatal outcomes were assessed using the Apgar scale. The results demonstrated that the epidural alone took longer to relieve symptoms than the CSE (8.70 +- 1.68 min vs. 1.25 +- 0.44 min; P <.01). However, the incidence of motor weakness (91.4% vs 16.1%; P <.0001) and foetal bradycardia (30.6% vs 10.8%; P <.01) was significantly lower in the CSE group than in the epidural group. Other factors, such as mothers' satisfaction, labour outcomes, Apgar scores, and UVB pH were similar in both groups. Although the total dose of fentanyl and mean UVB fentanyl levels were similar in both groups, they were significantly correlated to the fentanyl dosing administered within 3 hours of delivery. "When the delivery occurred, the total dose of fentanyl did not influence foetal levels beyond 3 hours' time," explained Dr. Arya. He added, "Only the last 3 hours were significant for foetal drug levels." Based on these results, the researchers concluded that both epidurals and CSEs constituted effective approaches to labour analgesia. "The epidural had slower onset at first dose, but that did not affect parturient satisfaction," said Dr. Arya. In addition, the epidural alone carried a lower risk of motor blockade in the legs and a reduced risk of foetal bradycardia at first dose. Fentanyl use was only correlated to foetal fentanyl levels if given within 3 hours of delivery and did not seem to impact Apgar scores.
[Presentation title: Comparison of Epidural With CSE for 'Walking Labour Analgesia' and Fetal Fentanyl Levels at Delivery. Abstract A1766]
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