Abstract
Purpose
Epidural fentanyl after a lidocaine and epinephrine test dose, provides adequate analgesia and allows for ambulation during early labour. The current study was designed to determine the influence of hydromorphone added to an epidural fentanyl bolus (e.g., whether there is an increase in duration of analgesia).
Methods
Forty-four labouring primigravid women, at less than 5 cm cervical dilation, who requested epidural analgesia were enrolled in this randomized, double-blind study. After a 3 mL test dose of lidocaine with epinephrine, patients received fentanyl 100 μg (in 10 mL volume). They randomly received the fentanyl with either saline or hydromorphone (300 μg).
After administration of the initial analgesic, pain scores and side effects were recorded for each patient at ten, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used.
Results
The patients were taller in the hydromorphone group (P < 0.04). There were no other demographic differences between the two groups. The mean duration prior to re-dose was not significantly different in the group that received hydromorphone ( 135 ± 52 min) compared to the control group (145 ± 46 min). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block.
Conclusion
In early labouring patients, the addition of hydromorphone (300 μg) to epidural fentanyl (100 μg after a lidocaine and epinephrine test dose) neither prolongs the duration of analgesia nor affects the ability to ambulate, and cannot be recommended according to the current study.
Résumé
Objectif
Ladministration épidurale de fentanyl suivant une dose test de lidocaine et d’épinéphrine fournit une analgésie adéquate et permet de marcher au début du travail obstétrical. La présente étude cherchait à déterminer l’influence d’un ajout d’hydromorphone au bolus de fentanyl épidural. Entre autres, l’analgésie est-elle prolongée?
Méthode
Quarante-quatre primigestes en travail chez qui la dilatation du col était de moins de 5 cm et qui avaient demandé une analgésie épidurale ont été recrutées pour l’étude randomisée et à double insu. Après avoir reçu une dose test de 3 mL de lidocaine avec de l’épinéphrine, les patientes ont eu 100 μg de fentanyl (dans un volume 10 mL). Elles ont reçu de façon aléatoire le fentanyl et, soit une solution salée, soit de l’hydromorphone (300 μg). Après l’administration de l’analgésique initial, les scores de douleur et les effets secondaires ont été enregistrés pour chaque patiente à dix, 20 et 30 min et à toutes les 30 min par la suite par un observateur objectif.
Résultats
La seule caractéristique personnelle différente entre les patientes des deux groupes était que les patientes ayant reçu l’hydromorphone étaient plus grandes (P < 0,04). Que ce soit avec l’hydromorphone (135 ± 52 min) ou la substance témoin (145 ± 46 min), le temps moyen précédant une seconde dose était comparable. Les effets secondaires ont été similaires dans les deux groupes. Aucune patiente n’a expérimenté de blocage moteur détectable.
Conclusion
Au début du travail, l’ajout d’hydromorphone (300 μg) à l’administration péridurale de fentanyl (100 μg après une dose test de lidocaine et d’épinéphrine) ne prolonge pas l’analgésie et n’affecte pas la capacité de marcher. Il ne peut être recommandé selon la présente étude.
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Parker, R.K., Connelly, N.R., Lucas, T. et al. The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour. Can J Anesth 49, 600–604 (2002). https://doi.org/10.1007/BF03017388
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DOI: https://doi.org/10.1007/BF03017388