Abstract
Maintenance of continuous epidural analgesiafor obstetrics by slow infusion is a feasible alternative to maintenance by intermittent injection. The method described by Davies and Fettes using 0.25 per cent bupivacaine through a 6 ml/hr capillary flow device (Intraflo®), with the fast-flush cut-off, is simple and convenient. However, failure of the fast-flush valve, resulting in a high flow rate, has been reported. It is therefore imperative that, prior to connecting the pressurized system to the epidural catheter, correct function of the device be verified by observing the flow rate in the microdrip chamber. We have used this method for the past year and found the equipment reliable, but in order to achieve more satisfactory analgesia the concentration of the infusion was increased initially to 0.375per cent, and then reduced to 0.30 per cent.
The records of the first 187 patients were reviewed retrospectively. Group I(n = 99) received an infusion of 0.25 per cent bupivacaine, Group II (n = 49) received 0.30 per cent and Group II (n = 39) received 0.375 per cent. Significantly more patients in Group I (30 per cent) required supplementary top-ups (in addition to the infusion) for the first stage of labour than in either Group II (10 per cent), or Group III (13 per cent). Top-ups for delivery were given to 55 per cent of patients in Group I, 64 per cent in Group II and 48 per cent in Group III. The incidence of motor block was significantly higher in Group III (21 per cent) than in either Group 1(1 per cent) or Group II (2 per cent). For continuous epidural infusion at 6 ml/hr, 0.30 per cent bupivacaine combines optimum analgesia with minimal side-effects.
Résumé
L’entretien de l’analgésie épiduralepar infusion lente en obstétrique est une alternative possible aux injections intermittentes. La méthode, décrite par Davies et Fettes, utilisant 0.25 pour cent de bupivacaine passant dans un tube capillaire (Intrqflo®) à 6 mllheure avec la valve de fiux hors d’action est simple et commode. Cependant on a observé un défaut dans la valve de flux, ce qui a résulé en un écoulement très rapide. II est done impératif avant d’attacher le sytème pressurisé au cathéter épidural, de vérifier le bon fonctionment de la valve en vérifiant la vitesse de l’écoulement dans la chambre microdrip. Nous utilisons cette méthode depuis un an et nous avons trouvé ce dispositif ejficace mats afin d’obtenir une analgésie satisfaisante nous avons augmenté la concentration de l’infusion à 0.375 pour cent initialement et nous l’avons ensuite réduite à 0,30 pour cent. Nous avons révisé les données chez les 187 premières patientes. Le Groupe I(n = 99) reçut une infusion de 0.25 pour cent de bupivacaine. Le Groupe II (n = 49) reçut 0.30 pour cent et le Groupe II (n = 39) reçut 0.375 pour cent. Significative-mentplus de patientes dans le Groupe I (30 pour cent) ont eu besoin d’une dose supplémentaire à l’infusion initiaie durant le premier stage du travail que chez le Groupe II (10pour cent) ou le Groupe III (13 pour cent). Une dose additionnelle fut ajoutee pour I’accouchement a 55 pour cent des patientes du GroupeI, d.64 pourcent du Groupe H et a 48 pour cent du Groupe HI. Uincidence du bloc moteur 6tait significativemenl plus ileve’e chez le Groupe HI (21 pour cent) que chez le Groupe I (1 pour cent) ou chez le Groupe II (2 pour cent). Pour I’infusion épidurale continuelle à 6 mllheure, 0.30 pour cent de bupivacaine a un effet optimum pour l’analgésie avec un minimum d’effets secondaires.
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Taylor, H.J.C. Clinical experience with continuous epidural infusion of bupivacaine at 6 ml per hour in obstetrics. Can Anaesth Soc J 30, 277–285 (1983). https://doi.org/10.1007/BF03013808
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DOI: https://doi.org/10.1007/BF03013808