• C Harms, M Siegemund, S C Marsch, D V Surbek, I Hösli, and M C Schneider.
• Department of Anaesthesia, University of Basel, Kantonsspital, Basel, Switzerland. harms@ubaclu.unibas.ch
• Fetal. Diagn. Ther. 1999 Nov 1;14(6):368-74.

ObjectivePotential effects of extradural analgesia on the progress of labour and obstetric outcome are still a matter of concern and the focus of ongoing debates. Despite this, little attention is paid to the initiation of extradural labour analgesia. The objective of this prospective, randomized, double-blind trial was to identify the optimal of three concentrations of bupivacaine used as a loading bolus for initiating extradural analgesia during labour.MethodsSixty-seven full-term parturients requesting extradural analgesia received either bupivacaine 0.25% (group A), 0.125% (group B) or 0. 0625% (group C). Bupivacaine administration was titrated to achieve a pain score ResultsThe probability of obtaining a VAS pain score /=1 based on using a modified Bromage scoring scale. There were no differences in incidence of maternal hypotension, ephedrine requirements, foetal heart rate abnormalities, mode of delivery and neonatal outcome.ConclusionsOf the three concentrations used in this clinical setting, 0.125% was the most suitable concentration of plain bupivacaine to initiate extradural analgesia in labour. Using 0.25% bupivacaine increased the incidence of motor block, whereas for 0.0625% plain bupivacaine the probability to achieve adequate analgesia was unacceptably low.Copyright 1999 S. Karger AG, Basel

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