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A Randomized Controlled Study Assessing Bupivacaine Temperature on Epidural Labor Analgesia
Abstract Number: GM 6
Abstract Type: Original Research
INTRODUCTION: Although labor epidural analgesia represents an effective form of pain relief, its slow onset and duration of satisfactory analgesia can be limitations. The administration of warmed, compared to room temperature, bupivacaine (0.5%) results in spinal or epidural blockade for cesarean delivery that has more rapid onset, more extensive distribution, and less need for supplementation. We hypothesized that similar advantages, for potentially the entire duration of labor, could be realized with an epidural analgesia technique using bupivacaine administered at body versus room temperature.
METHODS: A total of fifty-four nulliparous women in labor were randomized to receive epidural bupivacaine (0.125% with fentanyl 2 mcg/mL) 20 mL at either body or room temperature (37°C or 20°C, respectively) followed by hourly 6 mL boluses of the same mix. Visual analog pain scores, sensory block level, oral temperature, and side effects were assessed after epidural loading (time 0), at 5, 10, 15, 20, 30, 60 minutes, and at hourly intervals. Analgesic onset was defined as time to achieve VAS ≤ 3. The study endpoint was vaginal delivery or decision to undergo cesarean delivery.
RESULTS: Fifty women (25 in each group) completed the study. There were no differences between groups in patient demographics, initial pain scores, baseline temperature, or mode of delivery. Bupivacaine at 37°C resulted in shorter analgesic onset time (9.2±4.7 minutes vs. 16.0±10.5 minutes; p=0.005) and improved analgesia particularly in the first 15 minutes (Figure 1). Although patient temperature increased during the study (p<0.05), there was no difference between the 37° C and 20°C temperature groups (0.3°±0.8°F vs. 0.8°±1.0°F; p=0.09). Six (24%) and 10 (40%) patients experienced shivering in the 37°C and 20°C groups, respectively (p=0.23).
DISCUSSION: The administration of epidural bupivacaine with fentanyl at 37°C versus 20°C resulted in faster onset and improved labor analgesia. Patient temperature increased during the study, with a trend towards a larger increase in the room temperature group. There were no differences in side effects between groups.
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