Epidural Fentanyl Produces Labor Analgesia by a Spinal Mechanism

Background The purpose of this study was to determine if epidural fentanyl produces analgesia in laboring patients by a primary spinal or supraspinal action. Methods Fifty‐four parturients were randomized to receive epidural 0.125% bupivacaine plus one of three treatments: epidural saline‐intravenous saline, epidural fentanyl (20 [micro sign]g/h)‐intravenous saline, or epidural saline‐intravenous fentanyl (20 [micro sign]g/h). The study treatments were administered by continuous infusion, whereas epidural bupivacaine use was patient controlled. Results Epidural bupivacaine use was significantly reduced by epidural (11.5 +/‐ 4.6 ml/h) but not by intravenous fentanyl (15.9 +/‐ 4.5 ml/h) compared with saline control (16 +/‐ 5.9 ml/h). Analgesia characteristics and side effects were similar among groups. Conclusions Low‐dose epidural infusions of fentanyl produce labor analgesia by a primary spinal action.

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