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Korean J Anesthesiol > Volume 41(6); 2001 > Article
Korean Journal of Anesthesiology 2001;41(6):699-706.
DOI: https://doi.org/10.4097/kjae.2001.41.6.699   
Comparison between Epidural Analgesia and Combined Spinal-Epidural Analgesia for Labor and Delivery.
Heung Seo Park, Sin Young Yang, Seok Hwa Yoon, Soo Chang Son
1Department of Anesthesiology, College of Medicine, Chungnam National University, Daejeon, Korea. seohwy@cuvic.cnu.ac.kr
2Department of Anesthesiology, College of Medicine, Sungkyunkwan University, Seoul, Korea.
Abstract
BACKGROUND
This study was designed to compare analgesic efficacy and side effects of intrathecal morphine and fentanyl with epidural bupivacaine.
METHODS
Twenty nine healthy women, ASA physical status 1 or 2 with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural or combined spinal-epidural analgesia. In the epidural analgesia group (n = 18), 0.25% bupivacaine 8 - 10 ml and fentanyl 50 - 75ng was injected into the epidural space. In the CSE group (n = 11), analgesia performed dural puncture with a 27 gauge spinal needle and fentanyl 15ng and morphine 0.2 mg in 2 ml normal saline solution was injected. In both groups, whenever the patient requests further analgesia, we injected 0.125% bupivacaine 10 ml and fentanyl 50 - 75ng into the epidural space.
RESULTS
There was no significant difference between the two groups in duration of analgesia, the second stage of labor and pushing. The CSE group offers rapid onset time. The total dose of bupivacaine and fentanyl administered during analgesia was significantly more in the epidural group than the CSE group. After intrathecal fentanyl 15ng and morphine 0.2 mg, the duration of analgesia was 162 +/- 122 min. After the first 0.25% bupivacaine 10 ml and fentanyl 50 - 75ng, it was 92.5 +/- 5 min in the epidural group and 190 +/- 101 min in the CSE group (P < 0.05).
CONCLUSIONS
Compared with epidural analgesia, Intrathecal fentanyl 15ng and morphine 0.2 mg as part of CSE analgesia provide rapid onset time and prolonged analgesia, and a lower total dose of local anesthetics for labor and delivery. However women who received CSE analgesia were more likely to itch (64%) than solely epidural analgesia.
Key Words: Analgesics: fentanyl; morphine; Anesthetic technique: intrathecal; Anesthetics, local: bupivacaine
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