Regional analgesia – establishing regional analgesia in labour (different doses for initiation of epidural analgesia)

Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Plaat FS;Royston P;Morgan BM;

1996221
RCTEvidence level: 1+N=60(30 for each)women in labour requesting epidural analgesiaIntervention: bupivacaine 15mg plus fentanyl 50 mcg for initiation of epidural analgesiaComparison: bupivacaine 25mg plus fentanyl 50 mcgFollow-up period: intrapartumOutcome Measures: efficacy and adverse eventsduration of analgesia
15mg: 80 (35–100) min
25mg: 98 (25–300) min

Number able to raise leg
15mg: 100%
25mg: 77%

Number able to walk
15mg: 77%
25mg: 20%
not stated
Christiaens F;Verborgh C;Dierick A;Camu F;

1998 Mar 220
RCTEvidence level: 1+N=58 (0.5% bupivacaine(1) =19; 0.2% bupivacaine(2) =19; 0.1% bupivacaine(3) =20)women in labour requesting epidural analgesiaIntervention: 0.2 or 0.1% bupivacaine for epidural analgesiaComparison: 0.5%Follow-up period: intrapartumOutcome Measures: efficacyOnset of analgesia
1 12(8)min
2 7(2)min
3 11(6)min

duration of analgesia
1 43(21)min
2 100(26)min
3 120(21)min
not stated
Beilin Y;Galea M;Zahn J;Bodian CA;

1999 Jun 219
RCTEvidence level: 1+N=68
0.2%=28
0.15%=28
0.1%=12
women in labour requesting epidural analgesiaIntervention: Ropivacaine 0.2% for initiation of epidural analgesiaComparison: ropivacaine 0.15% and 0.10%Follow-up period: intrapartumOutcome Measures: efficacy and adverse eventsduration of analgesia
0.20% 110(32)min
0.15% 96(38)min
0.10% 64(28)min

No motor block
0.20% 22/28
0.15% 16/28
0.10% 4/12

Hypotension
0.20% 2/28
0.15% 1/28
0.10% 0/12

FHR decelerations
non reported
not stated

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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