Combined spinal epidural raises risk of foetal bradycardia
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Combined spinal epidural raises risk of foetal bradycardia Combined spinal epidural analgesia increases the risk of foetal bradycardia versus standard epidural, concludes a US-based retrospective study presented at the 2010 Annual Meeting of the American Society of Anesthesiologists. Researchers performed a chart review of all women admitted to the labour and delivery ward of UWMC, Seattle, Washington, during the period January–March 2009. A total of 173 eligible women were identified. Among these, 91 received combined spinal epidural (isobaric bupivacaine 2.5mg + fentanyl at an average dose of 20µg; followed by PCEA* with bupivacaine 0.0625% + fentanyl 2µg/mL 10 mL/h, bolus 5mL, lock-out 10 min). The remainder received standard spinal epidural analgesia (bupivacaine 0.25% 8–15mL, followed by fentanyl 50–100mg and a similar PCEA regimen). Foetal bradycardia occurred in 14 combined spinal epidural recipients (15%), compared with 3 standard epidural recipients (4%; RR 4.26, 95% CI 1.27, 14.28, p ≤ 0.009). Parity did not influence the risk of developing bradycardia, and caesarian delivery rates and neonatal outcomes were similar between groups. The researchers say that further research is needed to ascertain the "optimal dose of spinal fentanyl . . . that may if at all reduce the incidence" of foetal bradycardia following combined spinal epidural. * patient-controlled epidural analgesia Landau R, et al. Fetal Bradycardia during Labor Analgesia: Combined Spinal Epidural (CSE) Versus Standard Epidural. 2010 Annual Meeting of the American Society of Anesthesiologists : abstr. A548, 16 Oct 2010. Available from: URL: 803043433 http://www2.asahq.org
0114-9954/10/1326-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 6 Nov 2010 No. 1326
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