Article Notes
- Nausea & vomiting (NNH 10 each)
- Urinary retention (NNH 7)
- Pruritus (NNH 4)
- Respiratory depression (NNH 38-59 for IT morphine 0.05-0.5 mg)
- Successful catheter insertion on first attempt in 47%
- Satisfactory and uncomplicated analgesia in 55%.
- Dural puncture in 4%.
- Subdural catheterization in 4%.
This meta-analysis investigated the benefits and risks of intrathecal morphine and fentanyl, concluding that:
Intrathecal morphine prolongs post-operative analgesia on average more than 8 hours, but at cost of:
Intrathecal fentanyl prolongs post-operative analgesia on average almost 2 hours, but at a cost of pruritus (NNH 3).
A case report and brief literature review examining the efficacy and complications of labor epidural analgesia in patients with Harrington rods after scoliosis surgery.
Ho, Ngan Kee & Chung reviewed 52 reported cases in the literature showing:
Lowest success rates, highest repeated-attempts and highest complication rates (DP 8%, failure 8%, poor analgesia 55%) occurred in those with a spinal surgery scar extending below the epidural insertion point.
Articles of interest relevant to labor epidural analgesia, both specifically focusing on obstetric epidurals and more peripherally relevant to obstetric labor analgesia.
This follow-up paper to the original COMET study describes in detail the high and low-dose epidural techniques and the subsequent anesthetic characteristics.
The low-dose techniques used infusions of 0.1% bupivacaine with 2 mcg/mL fentanyl, compared with 10mL boluses of 0.25% bupivacaine. Maternal analgesia experience was similar between the groups, all the CSE group experienced better analgesia in the first hour.
The COMET trial was a landmark study demonstrating the benefit on mode of delivery of using either a low-concentration (0.1% bupivacaine + 2mcg/mL fentanyl) epidural infusion or a combined spinal-epidural technique, over a traditional high-dose (10mL boluses of 0.25% bupivacaine) epidural.
Vaginal delivery rate was significantly higher in the low-dose (OR 1.38) and CSE (OR 1.39) groups than in the traditional high-dose group.