A comparison between intrathecal sufentanil and a combination of sufentanil and mini-dose of bupivacaine for labor analgesia

Background and objectives - Intrathecal opioids can provide labor analgesia. The aim of this study was to evaluate whether a single dose of intrathecally administered sufentanil provides adequate pain relief during labor and delivery compared to a combination of the same dose of sufentanil and a small dose of bupivacaine. Methods - One hundred parturients requesting labor analgesia received an intrathecal injection of either 15 μg of sufentanil (Group A, n = 50) or a combination of 15 μg of sufentanil with 2 mg of bupivacaine (Group B, n=50). Time to onset and duration of analgesia were evaluated in minutes. The effectiveness of analgesia was evaluated using a visual analog scale. Heart rate, respiratory rate and blood pressure were recorded. The incidence of nausea, vomiting, pruritus and somnolence was assessed. Neonates were evaluated by means of Apgar score and measurements of umbilical cord blood gases. Results - Fast onset of analgesia was obtained in both groups (Group A- 2.5 ± 1.1 min and Group B- 1.8 ± 1.1 min, NS). Duration of pain relief was longer (Group A- 98 ± 26 min and Group B- 156 ± 41 min p < 0.001) and visual analog scores were lower with the combination of drugs. Pruritus of mild intensity was the main side-effect recorded. Neonates showed normal values in Apgar scores and umbilical blood gases. Conclusions - The combination of 15 μg of sufentanil with 2 mg of bupivacaine provided effective and long-lasting analgesia, with few side-effects and no detrimental effects on the neonates. The technique requires further evaluation in other obstetrical settings so that its actual role in labor analgesia can be established.