Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal alfentanil with and without bupivacaine for analgesia in labour.
Combined spinal-epidural (CSE) for analgesia in labour is widely used as a method of providing pain relief while minimising motor blockade. Aiming to further reduce the associated motor weakness, we investigated the use of alfentanil alone as the initial intrathecal injection in a double-blind study. Thirty women were randomly allocated to receive either alfentanil 0.25 mg with bupivacaine 2.5 mg intrathecally, or alfentanil 0.25 mg in the same volume. ⋯ Sixty per cent of women receiving the alfentanil-bupivacaine mixture demonstrated an impaired ability to straight leg raise compared with none of the women in the alfentanil-saline group (p < 0.01). The incidence of adverse effects in mother and fetus was similar in both groups. We conclude that intrathecal alfentanil 0.25 mg alone as part of a CSE technique provides rapid analgesia of satisfactory quality without detectable motor blockade.
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Spinal anaesthesia should not be performed above the L3/4 interspace if relying on surface anatomy to determine spinal level.
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Anaesthetists are inaccurate when identifying lumbar spinal interspace level using bony landmarks.
pearl