Combined spinal-epidural analgesia in labor.

Background: Combined spinal-epidural (CSE) analgesia is becoming increasingly used to provide pain relief during labor. It combines both the rapid onset of the spinal analgesia and the flexibility of the epidural catheter. Intrathecal sufentanil provides rapid-onset and profound analgesia during the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. The major concern of the anesthesiologist is to limit these side effects sources of discomfort to a parturient, by choosing the optimal dose of sufentanil or searching for an alternative. The purpose of this study is to compare tramadol and sufentanil used in CSE analgesia in terms of duration of analgesia and frequency of adverse maternal or fetal effects. Methods: Forty parturients requesting labor analgesia were included in this prospective study. In a combined spinalepidural technique, at 3 to 4 cm cervical dilation, patients were randomly assigned to receive either one of the following intrathecal solutions: 2.5 mg sufentanil (n = 20) and 2.5 mg bupivacaine, or 25 mg tramadol (n = 20) and 2.5 mg bupivacaine. Visual analog scores for pain, blood pressure, heart rate, sensory levels, * From Department of Anesthesia and Critical Care. Mongi Slim Hospital, Sidi Daoud, Tunisie. Corresponding author: Professeur Mohamed Salah Ben Ammar, Service d’Anesthésie Réanimation Urgences, Hopital Mongi Slim-Sidi Daoud 2046-Tunisie, Tel: +21671764845, Fax: +21671730324, E-mail: [email protected].