• S W Lindow, A R Dhillon, S W Husaini, and I F Russell.
• Department of Obstetrics and Gynaecology, Women and Children's Hospital, Hull Royal Infirmary, The University of Hull, Kingston upon Hull, UK.
• BJOG. 2004 Oct 1;111(10):1075-80.

ObjectivesTo compare the effectiveness of two different methods for epidural analgesia in the second stage of labour-fentanyl alone versus the usual mixture of bupivicaine and fentanyl.DesignA double-blind, randomised, controlled trial.SettingAn English maternity hospital.SampleEighty nulliparous women in the second stage of labour.MethodsAfter successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl-only solution given at the same rate.Main Outcome MeasuresMode of delivery, duration of the second stage and quality of analgesia.ResultsThere was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02-1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3-1.0).ConclusionSecond stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.

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