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J Am Osteopath Assoc. 2006 Dec;106(12):692-8.

Hemodynamic stability during labor and delivery with continuous epidural infusion.

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1
William Jennings Bryan Dorn Veterans Hospital, 6439 Garners Ferry Road, Columbia, SC 29209-1638, USA.

Abstract

CONTEXT:

Epidural anesthesia for labor pain is frequently complicated by maternal hypotension.

OBJECTIVE:

To test whether continuous epidural infusion (CEI) of local anesthetic, without bolus administration, lowers the incidence of hypotension in parturient patients.

METHODS:

In a single-blind clinical study, subjects were randomly assigned to CEI-only (10 mL/h of 0.2% ropivacaine hydrochloride without bolus) or control (10 mL of 0.2% ropivacaine hydrochloride per hour with 10-mL bolus) epidural dosing groups. The incidence of hypotension (20% decrease in systolic blood pressure or mean arterial pressure (MAP), systolic blood pressure lower than 100 mm Hg, or MAP lower than 65 mm Hg) was recorded for 2 hours after dosing. Statistical analysis included a 2x2 chi(2) analysis, the Fisher exact test, and paired two-tailed t tests.

RESULTS:

Fifty subjects were studied, with 25 randomly assigned to each study group (CEI-only vs control). Baseline blood pressure was not different between groups (CEI-only, 127 [11]/77 [8.7] mm Hg; control, 131 [14]/78 [2]). The incidence of hypotension was lower in the CEI-only group than in the control group (5 [20%] vs 15 [60%]; P=.009), with intervention required in 1 (20%) of 5 CEI-only subjects and 7 (47%) of 15 control subjects. Sensory block reached the T10 dermatome in 54.4 (18) minutes in the CEI-only group and 38 (24) minutes in the control group (P=.04). Pain scores and maternal and fetal pulse rates were not different between groups. Analgesic supplementation (250 microg of epidural fentanyl) was used more frequently in the CEI-only group (72% vs 32%; P=.01), without adverse effects.

CONCLUSIONS:

Continuous epidural infusion of 0.2% ropivacaine hydrochloride without bolus administration reduces the incidence of hypotension by 67% and is safer than traditional bolus dosing for routine labor. This method requires further study in high-risk patients, including those with preeclampsia and cardiovascular disease.

PMID:
17242413
[Indexed for MEDLINE]

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