AUTHORS: Väänänen A et al
Acta Anaesthesiologica Scandinavica (Jul 2019)
METHODS The parturients were randomly assigned to groups receiving either spinal sufentanil (5ug), epidural sufentanil (20ug), spinal fentanyl (20ug), or epidural fentanyl (100ug), whereafter the parturients were monitored for reported pain during contraction and side effects for thirty minutes. The primary outcome was the level of analgesia achieved within 20 minutes,while the secondary outcome was the time until the administration of the first epidural bolus.
RESULTS At baseline, the mean maximum pain VAS was 86(84-89)mm. At 20 minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl or epidural fentanyl, the maximum VAS was 19(7-31)mm, 45(32-59)mm, 25(10-39)mm, or 52(40-63)mm, respectively (p<0.01 spin vs. epid groups). There were no differences in efficacy between spinal or epidural sufentanil and fentanyl. The mean(95% CI) time to the activation of epidural analgesia was 151(111-192), 130(93-168), 177(121-234), and 112(80-143) minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl and epidural fentanyl, respectively.
CONCLUSIONS In terms of a reduction of VAS score at 20 minutes, epidural sufentanil or fentanyl provide 63% and 60% of the analgesic effect of the corresponding spinal analgesia. Epidural sufentanil or fentanyl could be used in situations in which spinal/CSE administration is not possible or desired.