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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-11-2013 | Reports of Original Investigations

The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

Authors: Jill M. Mhyre, MD, Richard W. Hong, MD, Mary Lou V. H. Greenfield, MPH, Nathan L. Pace, MD, Linda S. Polley, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2013

Abstract

Purpose

Neuraxial hydromorphone has been reported to provide rapid onset of labour analgesia, effective segmental pain relief, and a longer duration of action than commonly used lipophilic opioids. This study was conducted to test the hypothesis that intrathecal hydromorphone reduces the dose requirement for intrathecal bupivacaine to induce rapid analgesia for women in the first stage of labour.

Methods

In this double-blind randomized controlled sequential allocation trial, 88 labouring parturients received combined spinal-epidural analgesia at 2-6 cm cervical dilation. Participants received intrathecal bupivacaine alone or bupivacaine plus hydromorphone 100 μg with the bupivacaine dose determined using up-down sequential allocation. An effective dose was defined as a visual analogue pain score of ≤10 mm (on a 100-mm pain scale) reported within 20 min of injection. The median effective doses were calculated using the formula of Dixon and Massey and verified using isotonic regression.

Results

A decrease was observed in the median local analgesic doses (effective dose [ED50]) estimated according to the formulas of Dixon and Massey, with a between-group difference of −0.45 mg. The precision of the estimate was wide-ranging (95% confidence interval −1.23 to 0.33), so no definitive conclusion can be drawn.

Conclusion

Further research is needed to determine whether or not intrathecal hydromorphone 100 μg changes the dose of intrathecal bupivacaine required to induce labour analgesia within 20 min.

Trial registration

The trial was conducted in 2007 prior to widespread acceptance of the standard for clinical trial registration.

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Title: The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial
Authors: Jill M. Mhyre, MD
Richard W. Hong, MD
Mary Lou V. H. Greenfield, MPH
Nathan L. Pace, MD
Linda S. Polley, MD
Publication date: 01-11-2013
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 11/2013
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-013-0023-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour: a double-blind randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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