Fentanyl-only epidural infusion shows no benefit over fentanyl/bupiv in respect to duration of labor, motor block, delivery, analgesia, or outcomes.

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• Margaret G Craig, Erica N Grant, Weike Tao, Donald D McIntire, and Kenneth J Leveno.
• From the Department of Anesthesiology and Pain Management (M.G.C., E.N.G., W.T.) and Department of Obstetrics and Gynecology (D.D.M., K.J.L.), The University of Texas Southwestern Medical Center, Dallas, Texas.
• Anesthesiology. 2015 Jan 1; 122 (1): 172-7.

BackgroundThe purpose of this prospective, double-blinded, parallel-arm, randomized trial was to examine the effects of epidural bupivacaine on the length of the second stage of labor in nulliparous women.MethodsThe authors assessed length of second-stage labor, degree of motor blockade, mode of delivery, and visual analog scores in 310 nulliparous women with labor epidurals randomized to receive either: (1) 0.125% bupivacaine and fentanyl 2 μg/ml or (2) fentanyl 10 μg/ml alone via epidural using double blinding.ResultsThe median duration of the second stage was 75 min (41, 128) in the bupivacaine/fentanyl group versus 73 min (42, 120) in the fentanyl-only group (P = 0.17) with a median difference of 6.0 (95% CI, -6.0 to 18.0). Furthermore, there was no difference in degree of motor blockade, incidence of operative delivery, visual analog scores, or neonatal outcomes between the two groups. No adverse events were reported.ConclusionsUse of epidural bupivacaine/fentanyl or a fentanyl-only infusion during the second stage of labor did not affect the duration of the second stage of labor, degree of motor blockade, mode of delivery, pain relief, and maternal or neonatal outcomes. However, in the fentanyl-only infusion group, there was a fivefold increase in opioid exposure to the fetus with unknown effects on neurobehavior, an outcome not assessed beyond the immediate postnatal period in this study.

This article appears in the collections: Interesting obstetric epidural articles, Breastfeeding and epidural fentanyl, and Regional stuff.

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