[Addition of fentanyl to bupivacaine--peridural analgesia in cesarean section]

Parenteral Pethidine for labour pain relief and substance use disorder: 20-year follow-up cohort study in offspring

OBJECTIVE

To determine whether use of intrapartum Pethidine pain analgesia increases the risk for substance use disorder in adult offspring.

DESIGN

Analysis of data from a cohort study.

SETTING

Academic hospital in Leiden, the Netherlands.

PARTICIPANTS

133 cases and 164 control individuals, aged 18-20 years at follow-up.

MAIN OUTCOME MEASURE

Incidence of substance use disorder or use of alcohol and tobacco.

RESULTS

The lifetime use of addictive substances in children exposed to intrapartum Pethidine analgesia was 45% of 133 children versus 48% of 164 not-exposed subjects (adjusted OR=0.79, 95% CI 0.48 to 1.29). Recent use of alcohol, tobacco and hard drugs showed no statistical difference either.

CONCLUSION

Pethidine for labour pain medication appears not to be associated with substance misuse or smoking in later life.

Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for Caesarean section

BACKGROUND

This prospective double-blind trial evaluated the effect of sufentanil addition to epidural ropivacaine for elective Caesarean section.

METHODS

Sixty healthy parturients were randomly assigned to receive an initial dose of 90 mg of plain ropivacaine, or 90 mg of ropivacaine plus 10 or 20 microg of sufentanil (n = 20 each). Before surgery, if necessary, additional epidural ropivacaine was injected. Primary outcome parameter was time to achieve sensory block at T4.

RESULTS

Time to reach the sensory block was remarkably reduced (P < 0.001 each) by addition of 10 or 20 microg of sufentanil (21 +/- 8 min, 15 +/- 5 min, 11 +/- 4 min in the plain ropivacaine, the 10- and 20-microg sufentanil groups, respectively) whereas the visual analogue scale (VAS) scores at delivery were significantly reduced (P = 0.028) only by 20 microg of sufentanil (32 +/- 35 mm in the plain ropivacaine vs. 9 +/- 19 mm in the 20-microg sufentanil groups). The total dose of ropivacaine was significantly lower (P = 0.005) in patients receiving 20 microg of sufentanil (100.5 +/- 15.0 mg) compared with those treated with plain ropivacaine (118.5 +/- 17.3 mg). The incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus) and neonatal outcome [APGAR score, neurologic and adaptive capacity (NAC) score, umbilical cord blood-gas values] did not differ between the groups.

CONCLUSION

Our results suggest that addition of 20 microg of sufentanil improved the epidural anaesthesia with ropivacaine 0.75% for Caesarean section.

Epidural fentanyl, adrenaline and clonidine as adjuvants to local anaesthetics for surgical analgesia: meta-analyses of analgesia and side-effects

BACKGROUND

The risk/benefit ratio of adding fentanyl, adrenaline and clonidine to epidural local anaesthetics for improving intraoperative analgesia is unclear. This meta-analysis was performed to clarify this issue.

METHODS

Trials retrieved by search were considered if they were prospective, controlled, epidural analgesia (without combining general anaesthesia) was planned and occurrence of pain during surgery or side-effects were reported. Papers entered meta-analysis if they reached a predefined minimum quality score. Pooled odds ratios (OR) and confidence intervals (CI) were computed. P < 0.05 was considered as significant.

RESULTS

Eighteen trials were included in the analysis for fentanyl. Fentanyl decreased the likelihood of pain (OR = 0.21, 95% CI = 0.15-0.30, P < 0.001) and increased the incidence of pruritus (OR = 5.59, 95% CI = 3.12-10.05, P < 0.001) and sedation (OR = 1.88, 95% CI = 1.19-2.98, P = 0.003), compared to control (local anaesthetic without fentanyl). Fentanyl had no effect on respiratory depression, nausea, vomiting and Apgar score. One case of respiratory depression of a newborn was observed. Because of the very low number of trials selected, evaluation of adrenaline and clonidine was not feasible.

CONCLUSION

The analysis of current literature shows that the addition of fentanyl to local anaesthetics for intraoperative epidural analgesia is safe and advantageous. The reduction in the incidence of pain during surgery is quantitatively high and therefore clinically significant. Side-effects are mild. Randomized, controlled trials have to be performed in order to clarify the role of adrenaline and clonidine as epidural adjuvants for surgical analgesia.