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The Relationship of Dural Puncture and Labor Epidural Associated Temperature Change
Abstract Number: SAT-37
Abstract Type: Original Research
The elevation in temperature with labor epidural analgesia contrasts with the reduction in temperature associated with spinal anesthesia.(1,2) The etiology for these differences in temperature modulation are not fully understood, however, centrally acting intrathecal opioids appear to create a reduction in temperature. Consequently, we hypothesized that women who receive a combined spinal epidural (CSE) or a dural puncture epidural (DPE) technique would have a less pronounced increase in temperature than those who received a conventional epidural technique.
This study is a secondary analysis of prospectively collected data from a randomized clinical trial assessing the efficacy and side-effect profiles of epidurals (EPL), DPE and CSE.(3) A total 120 healthy women at term gestation were randomly allocated to one of the three epidural groups. The EPL and DPE groups received an initial bolus of 20 mL of 0.125% bupivacaine with fentanyl 2 μg/mL, while the CSE group received bupivacaine 1.7mg and fentanyl 17μg. All groups received a background infusion of bupivacaine 1.25 mg/mL with fentanyl 2 μg/mL at 6 mL/h. Oral temperature was taken at the time of epidural placement and every ninety minutes until delivery. Multivariable linear regression models were fit to assess the association of epidural type (EPI, DPE, CSE) with the maximum change in temperature.
There were no clinically significant differences between the patients in each group. After controlling for maternal age, BMI, primiparity and length of epidural infusion there were no statistically significant differences when comparing each category of epidural and the magnitude of temperature change, although the mean temperature increase was less in the CSE group. See Table.
The presence of a dural puncture did not appear to significantly influence temperature change during labor epidural analgesia. Whether these findings are the result of the lipophilic properties of fentanyl and rapid clearance from the CSF, preferential binding to white matter, or the inability to penetrate deeper brain structures, will need further examination.(4-6)
1. Clinics in perinatology, 40(3), p.385-398.
2. Canadian Journal of Anesthesia 59(4),pp.384-388.
3. Anesth Analg. 2017 Feb; 124(2):560-569
4. Pain, 38(2), p.236.
5. The Journal of the American Society of Anesthesiologists92.3 (2000): 739-753.
6. Best Practice & Research Clinical Anaesthesiology, 16(4), pp.489-505.