Journal Report Epidural for Analgesia in Labor

8/9/2019 Journal Report Epidural for Analgesia in Labor

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Journal Report:

A Comparison of Minimum

Local Anesthetic Volumes and

Doses of Epidural

Bupivacaine (0!"#$ and

0"#$% for Anal&esia in La'or

Waldemar P. Siahaan, M.D.


2/17

“If the pharmacological sleeve is extended to

bathe all the available nerve root within the

epidural space, then a lower concentration

of local anesthetic will be sufficient to

block nerve transmission.”

Fink BR. Toward The mathematization of Spinal anesthesia. Reg Anesth Pain Med

19921!"2#$%!$


3/17

“Extending the pharmacological sleeve

requires that the volume of injectate is

increased at the expense of concentration.”

&hristiaens F. 'ffe(ts of dil)ent *ol)me of a single dose of epid)ral +)pi*a(aine in the

part)rients d)ring the first stage of la+or. Reg Anesth Pain Med 199,2$"1$-%-1


4/17

In fixed dose stud!

"igher volumes and lower concentrations are

more effective for nerve blockade when

compared with lower volumes of higher

concentration local anesthetics.#otential benefits in differential blockade, such

as motor sparing, when higher concentrations

are exchanged for lower concentrations givenin larger volumes

hiteside R. 'pid)ral ropi*a(aine with fentan/l following ma0or g/nae(ologi(al s)rger/" the effe(t of

*ol)me and (on(etration on pain relief and motor impairment. Br Anaesth 2,-"!2%-


5/17

$%&E'(I)E*!

(o +uantif an dose reduction which might

have potential implications for safet.

I-!

(o determine the median effective volumes and

doses, which were defined as the -) and

-/ of bupivacaine 0.1234 and 0.234 for

epidural bupivacaine given as the first bolus

to women for analgesia in labor.


6/17

-E("$/*!

I. #(IE5(*! 6omen in labor requesting neuraxial analgesia

* 1 or 2 patients

*ingleton pregnanc more than 78 wk $9

:110 kg in weight

%etween 130;1


7/17

-E("$/*!

II. E#I/>? (E'"5I+>E 1< g (uoh needl and 20 9 catheter

t the 2@7 or 7@= level, in a sitting position

>sing $?( 5o epidural test dose was given

#repared not more than = h previousl

Injected slowl over approximatel 3 min.

)#*

0 “no pain” 100 “worst pain ever”


8/17

-E("$/*!

III. 9?$>#* %upivacaine 0.1234

%upivacaine 0.234

)olume in the first sringe of each group set at13ml

Efficac of the first dose was assessed using a

)#* at 0,13, and 70 min after injection of thetest solution Afirst bolusB


9/17

-E("$/*!

I). ECCE'(I)E ?egardless of the baseline, )#* decreased to

10mm or less within 70 min of injection,

indicating the end of the stud, and directed adecrement of 2 ml local anesthetic for the next

woman


10/17

-E("$/*!

). I5ECCE'(I)E Cailure of the )#* to reach 10mm within 70

min

?escue analgesia consisting of 12ml bupivacaine 0.234 was given.

reduction in )#* to 10 mm or less

indicated the end of the stud

/irected a 2 ml increment for the next woman.


11/17

-E("$/*!

)I. ?E#E( Cailure to 10 mm after rescue directed that the

same concentration be repeated for the next

woman. Each da, 2 test sringes were made up, one

for each group and placed in refrigerator.

(he sringes were placed side b side, the

operator chose one or the other at random.


12/17

$%*E?)(I$5*

>se of prostin and oxtocin infusion, )#*,and efficac of the local anesthetic solution

were recorded.


13/17

*-#E *IDE

*ample sie estimations were based on theresults of the first studies that showed the

minimum local analgesic concentration of

bupivacaine to be 0.0834

&ol)m+ M3 &lini(al trials" )p%down se4)ential allo(ation. Regional analgesia in o+stetri(

5 a millenni)m )pdate. 2"16!%1#6


14/17

*-#E *IDE

minimum of 7F women would be required per group.


15/17

RE)L*

Bupivacaine

0!"# $

Bupivacaine0"# $

-) AmlB 17.8 A12.= G 1=.


16/17

'$5'>*I$5

%upivacaine 0.1234 when compared with0.234 produced equivalent analgesia with a

304 increase in volume, but with a 234

reduction in dose.

n reduction in dose, without loss of

efficac, reduces risk of toxicit and improves

safet.


17/17

THANK

YOU

Journal Report Epidural for Analgesia in Labor

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