Introduction:- Regional analgesia provides excellent pain relif in labour. This study was designed to compare combined spinal eqidural (CSE) versus epidural block using a narcotic (sufentanil) and local anaesthetic bupivacaine regarding their effects on progress of labour, method of delivery, pain relif, side effects and neonatal outcome.
Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study. The women were randomly allocated to receive either CSE or epidural ( 20 patient of each ). In CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block, were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous blood gases. Maternal and neonatal side effects were observed.
The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control group (A) injected intrathecally with saline, group (B) injected intrathecally with 1.5ug/kg sufentanil (low dose), and group (C) injected intrathecally with 7.5ug/kg sufentanil (high dose), the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and stained for histological evaluation.
Results:- The clinical study showed that no difference between the 2 groups for the degree of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of analgesia was faster with CSE technique, more patient satisfaction and more pruritis.
The histological results revealed that no detectable significant neurotoxic changes with the use of small dose of intrathecal sufentanil but mild changes occurred with high dose. Conclusion :- So the study concluded that both CSE and epidural analgesia with sufentanial and bupivaine can provide effective labour analgesia with minimal or no side effects.