Effects of Diluent Volume of a Single Dose of Epidural Bupivacaine in Parturients During the First Stage of Labor

Abstract

Background and Objectives0.1% bupivacaine for obstetric epidural analgesia is given by infusion, using a loading dose of a higher concentration alone or in combination with opioid analgesics. A single dose of 0.1% without any additive for relief of first-stage labor pain has not yet been documented.MethodsFifty-eight primiparae in active labor and with less than 5 cm cervical dilatation received 20 mg epidural bupivacaine diluted in 4 mL [group 1: 0.5% (I)], 10 mL [group 2: 0.2% (II)], or 20 mL [group 3: 0.1% (III)]. Pain relief, dermatomal spread, and motor block were assessed.ResultsVisual analog pain scale (VAS) was significantly lower in group 2 (0.88 ± 1.34) and group 3 (0.25 ± 0.61) than in group 1 (4.37 ± 2.57). Onset and time to maximum analgesia was significantly shorter in group 2 than in group 3. Mean duration of analgesia was 120 ± 21 minutes in group 3, 100 ± 26 in group 2, and 43 ± 21 in group 1. The mean numbers and upper limits of dermatomes blocked did not differ between groups 2 and 3, but were higher than in group 1. Motor blocks in groups 2 and 3 were more extensive than in group 1 with no difference between groups 2 and 3. Ten mL 0.2% or 20 mL 0.1% epidural bupivacaine results in a similar degree of pain relief, superior to that following 4 mL 0.5%, while duration was longest after 20 mL 0.1%.ConclusionsAnalgesia lasts significantly longer following 20 mL 0.1% bupivacaine than following 10 mL 0.2% bupivacaine when given for first-stage labor pain. Four milliliters 0.5% bupivacaine results in inadequate pain relief.