Journal article
A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia
Anesthesiology (Philadelphia), v 108(2), pp 286-298
Feb 2008
PMID: 18212574
Abstract
Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial.
Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7-10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status.
No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post-dural puncture headache, hemodynamic stability, or obstetric outcomes.
Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia.
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Details
- Title
- A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia
- Creators
- Valerie A Arkoosh - University of PennsylvaniaCraig M Palmer - Professor of Clinical Anesthesiology.Esther M Yun - Lenox Hill HospitalShiv K Sharma - The University of Texas Southwestern Medical CenterJames N Bates - University of IowaRichard N Wissler - University of RochesterJodie L Buxbaum - Pennsylvania State UniversityWallace M Nogami - University of ArizonaEdward J Gracely - Drexel University
- Publication Details
- Anesthesiology (Philadelphia), v 108(2), pp 286-298
- Publisher
- Lippincott
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- MD (Doctor of Medicine) Program
- Web of Science ID
- WOS:000252650200016
- Scopus ID
- 2-s2.0-38549107487
- Other Identifier
- 991019168410304721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Anesthesiology