alexa Epidural anesthesia for labor in an ambulatory patient.
Anesthesiology

Anesthesiology

Journal of Anesthesia & Clinical Research

Author(s): Breen TW, Shapiro T, Glass B, FosterPayne D, Oriol NE

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Abstract The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04\%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6\% of patients in the FENT group and 92.2\% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68\% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52\% for BEF and 21\% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17\% (P = 0.002) of BEF patients and orthostatic hypotension in 9\% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70\% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.
This article was published in Anesth Analg and referenced in Journal of Anesthesia & Clinical Research

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