Intrathecal Sufentanil Dose Response in Nulliparous Patients

Background Intrathecal sufentanil provides effective analgesia during the first stage of labor. A range of doses has been reported to provide adequate pain relief. This study determined the dose of intrathecal sufentanil that produced acceptable pain relief in 50% of nulliparous patients (ED50) who requested labor analgesia. Methods With institutional review board approval, 50 nulliparous patients requesting spinal opioid labor analgesia were enrolled into this prospective, randomized, double‐blinded study. Each patient was in spontaneous labor at <5 cm cervical dilation. Patients received one of the following doses of intrathecal sufentanil: 1, 2, 3, 5, or 10 [micro sign]g in 3 ml preservative‐free saline (n = 10 for each dose). Pain, pain relief, hemodynamic, respiratory, and side effect data were collected at times 0, 2, 5, 10, 15, 20, 25, and 30 min. Probit analysis of the number of patients in each group who requested additional pain medicine at 30 min was used to determine the ED50. Results The groups were demographically similar. The ED50 of intrathecal sufentanil was 1.8 [micro sign]g (SE, 0.6 [micro sign]g; 95% CI, 2.96 to 0.54 [micro sign]g). The incidence of side effects was similar among the groups. Conclusions This is the first study to determine the ED50 of intrathecal sufentanil in spontaneously laboring nulliparous patients. As dose‐response curves are determined for other labor analgesics, future studies can compare equianalgesic doses or dose combinations.

[1]  E. Riley,et al.  Intrathecal Sufentanil Produces Sensory Changes without Hypotension in Male Volunteers , 1998, Anesthesiology.

[2]  N. Herman,et al.  Determination of the Dose-Response Relationship for Intrathecal Sufentanil in Laboring Patients , 1997, Anesthesia and analgesia.

[3]  E. Riley,et al.  Intrathecal Sufentanil for Labor Analgesia: Do Sensory Changes Predict Better Analgesia and Greater Hypotension? , 1997, Anesthesia and analgesia.

[4]  M. Richardson,et al.  Densities of Dextrose-Free Intrathecal Local Anesthetics, Opioids, and Combinations Measured at 37 degrees C , 1997, Anesthesia and analgesia.

[5]  M. A. Rowe,et al.  A Comparison of the Local Anesthetic Effects of Meperidine, Fentanyl, and Sufentanil on Dorsal Root Axons , 1996, Anesthesia and analgesia.

[6]  M. Richardson,et al.  Density of Lumbar Cerebrospinal Fluid in Pregnant and Nonpregnant Humans , 1996, Anesthesiology.

[7]  S. Cohen,et al.  High sensory block after intrathecal sufentanil for labor analgesia. , 1995, Anesthesiology.

[8]  S. Ramanathan,et al.  Hemodynamic Effects of Subarachnoid Fentanyl in Laboring Parturients , 1995, Regional Anesthesia & Pain Medicine.

[9]  M. C. Sarna,et al.  Respiratory arrest after second dose of intrathecal sufentanil. , 1995, Anesthesiology.

[10]  L. Newman,et al.  Neither Intrathecal Sufentanil Nor Intrathecal Sufentanil Plus Nalbuphine Causes Hypotension in Laboring Parturients , 1994 .

[11]  C. Palmer,et al.  Respiratory depression after intrathecal sufentanil during labor. , 1994, Anesthesiology.

[12]  James,et al.  Intrathecal sufentanil labor analgesia: the effects of adding morphine or epinephrine. , 1994, Anesthesia and analgesia.

[13]  J. Eisenach,et al.  Intrathecal Sufentanil Compared to Epidural Bupivacaine for Labor Analgesia , 1994, Anesthesiology.

[14]  S. Ramanathan,et al.  Spinal Anesthesia for Labor Analgesia , 1994, Regional anesthesia and pain medicine.

[15]  S. J. Sharkey,et al.  Subarachnoid Labor Analgesia: Fentanyl and Morphine versus Sufentanil and Morphine , 1993, Regional Anesthesia & Pain Medicine.

[16]  Y. El‐Sayed,et al.  Intrathecal sufentanil for labor analgesia--sensory changes, side effects, and fetal heart rate changes. , 1993, Anesthesia and analgesia.

[17]  P. Harris,et al.  Redistribution of Sufentanil to Cerebrospinal Fluid and Systemic Circulation After Epidural Administration in Dogs , 1993, Anesthesia and analgesia.

[18]  S. Datta,et al.  A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia. , 1992, Anesthesiology.

[19]  B. Leighton,et al.  Comparison among intrathecal fentanyl, meperidine, and sufentanil for labor analgesia. , 1992, Anesthesia and analgesia.

[20]  C. Palmer,et al.  Early respiratory depression following intrathecal fentanyl-morphine combination. , 1991, Anesthesiology.

[21]  A. Sandler,et al.  Respiratory depression and spinal opioids , 1989, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  S. Datta,et al.  Effects of Fentanyl and Sufentanil on Peripheral Mammalian Nerves , 1987, Anesthesia and analgesia.

[23]  J. Han,et al.  Depressor and bradycardic effect following intrathecal injection of [NMePhe3,D-Pro4]morphiceptin in rats. , 1984, European Journal of Pharmacology.