B. Asokumar et al., INTRATHECAL BUPIVACAINE REDUCES PRURITUS AND PROLONGS DURATION OF FENTANYL ANALGESIA DURING LABOR - A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL, Anesthesia and analgesia, 87(6), 1998, pp. 1309-1315
Pruritus is a frequent complication (40%-100%) of intrathecal (IT) fen
tanyl 25 mu g (F) for labor analgesia. The addition of IT bupivacaine
2.5 mg (B) to F has been reported in a nonrandomized series to have a
17.3% incidence of pruritus. This study prospectively evaluated the in
cidence and distribution of pruritus in laboring parturients receiving
TT F + B. Sixty-five laboring parturients were randomly assigned to r
eceive IT F, B, or F + B as part of a combined spinal-epidural techniq
ue. Visual analog scores, sensory level, motor strength, and pruritus
were recorded before injection and at intervals thereafter. When prese
nt, the distribution of pruritus was evaluated. The duration of analge
sia was determined as the time from TT drug administration until the p
atient requested supplemental analgesia. The median duration of analge
sia in the F, B, and F + B groups was 62.5, 55.0, and 94.5 min, respec
tively. Compared with F alone, the combination of F + B led to a decre
ased frequency of pruritus (36.4% vs 95%). The incidence of facial pru
ritus (25%) was same in the F + B and F groups; however, the occurrenc
e of pruritus distributed over the rest of the body was significantly
more frequent in the F compared with the F + B group. The combination
of F + B prolongs the duration of labor analgesia compared with IT F o
r B alone. F + B also leads to a decreased incidence of pruritus, exce
pt in the facial region. Implications: When administered intrathecally
with fentanyl 25 mu g in laboring parturients, bupivacaine 25 mg atte
nuates the frequency of pruritus on all parts of the body except the f
ace. This combination also results in a rapid onset and prolonged dura
tion of labor analgesia compared with either drug alone.