Bupivacaine augments intrathecal fentanyl for labor analgesia

Background: Intrathecal fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low- dose bupivacaine added to intrathecal fentanyl for labor analgesia. Methods: Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 μg; bupivacaine, 1.25 mg, with fentanyl, 25 μg; or bupivacaine, 2.5 mg, with fentanyl, 25 μg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded. Results: Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 μg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged. Conclusions: The addition of 2.5 mg isobaric bupivacaine to 25 μg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with. plain intrathecal fentanyl.