Optimizing epidural fentanyl loading dose for early labor pain

Feng Fang Tsai, Gong Jhe Wu, Chen Jung Lin, Chi Hsiang Huang, Shiou Sheng Chen, Li Kuei Chen

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objective: Sufficient sensory blockade between L1 and T10 is required to relieve visceral pain during early labor. We examined whether the addition of fentanyl to a loading dose of 0.0625% bupivacaine could provide dose-dependent analgesic effects on early-stage labor pain. Methods: Sixty parturients who requested epidural analgesia for labor pain were enrolled and randomly allocated to one of three groups. Group A (n=20) received 10 mL of 0.0625% epidural bupivacaine as a loading dose alone. Group B (n=20) received the same bupivacaine loading dose in combination with 2 μg/mL fentanyl. Group C (n=20) received the same loading bupivacaine dose plus 4 μg/mL fentanyl. All patients received diluted bupivacaine plus 2 μg/mL fentanyl at a rate of 10 mL/hr as a maintenance dose. Fifteen minutes later, we recorded the highest cephalic and lowest caudal anesthetized dermatomes, side effects, and the number of patients who asked for supplemental analgesia. Results: The highest anesthetized cephalic dermatome was at the level of T12 (T9-L1) in Group A, T9 (T8-T12) in Group B and T7 (T5-T9) in Group C (p<0.05 among the three groups). Eleven patients (55%) requested supplemental bupivacaine for inadequate analgesia in Group A, six in Group B (30%), and none in Group C (0%). Pruritus was reported by seven (35%) patients in Group B and eight (40%) patients in Group C, but none in Group A. Conclusion: The addition of fentanyl to epidural bupivacaine dose-dependently increased the analgesic effect and higher loading doses of fentanyl increased the dermatomic coverage. We suggest that 0.0625% bupivacaine plus 4 μg/mL fentanyl is the ideal loading dose to provide the greatest segmental analgesia for early labor pain with minimal side effects.

Original languageEnglish
Pages (from-to)167-172
Number of pages6
JournalActa Anaesthesiologica Taiwanica
Issue number4
Publication statusPublished - Dec 2009
Externally publishedYes


  • Analgesia, obstetrical
  • Bupivacaine
  • Fentanyl
  • Labor pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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