Effect and safety of labor epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl on fetal and maternal outcomes and wellbeing

Rajesh Kesavan, Sunil Rajan, Lakshmi Kumar

Anesthesia: Essays and Researches 2018 12(4):769-773

Background: Labor analgesia has been shown to have few undesirable effects on the course and outcome of the labor as well as on the fetal well-being. Aims: This study aims to assess neonatal outcome following lumbar epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl. The secondary objectives included assessment of maternal analgesia, complications, and outcome of labor. Setting and Design: Prospective observational study conducted at a tertiary care teaching institute. Subjects and Methods: Sixty-three patients for labor epidural analgesia were recruited. Epidural catheter was inserted in L4–L5 or L3–L4 interspace. After confirmation of the position of catheter, 3 mL of 0.5% bupivacaine with 20 μg of fentanyl made to 15 mL was administered. After 30 min, efficacy of analgesia was assessed by visual analog scale (VAS). The same bolus dose was repeated after 90 min if the patient complained of pain. A maximum of five top-up doses were allowed. Statistical Test Used: Mean and standard deviation, number and percentage Results: After 30 min of first bolus dose, 93.3% had VAS score of <4. More than 90% patients had adequate analgesia till 4th epidural bolus. During contraction stress test, only two fetuses had late deceleration. About 80% and 98.3% newborns had Apgar of >7 at 1 and 5 min, respectively. Umbilical cord blood pH was ≥7.1 in 98.3% neonates with base excess of >−12. 58.3% delivered normally, 23.3% had instrumental vaginal delivery, and 18.3% required cesarean section. Conclusion: Lumbar epidural analgesia with 0.1% bupivacaine with fentanyl provides optimal neonatal outcome, labor analgesia, and labor outcome.

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