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British Journal of Anaesthesia, 1992, Vol. 69, No. 2 154-158
© 1992 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

COMPARISON OF THE MATERNAL AND FETAL EFFECTS ASSOCIATED WITH INTERMITTENT OR CONTINUOUS INFUSION OF EXTRADURAL ANALGESIA

J. M. EDDLESTON, M.B., CH.B., F.R.C.ANAES.1,*, M. MARESH, M.B., B.S., M.R.C.O.G.2, E. L. HORSMAN, M.B., CH.B., F.R.C.ANAES.1, H. YOUNG, R.G.N., R.M.2, P. LACEY, B.A., R.G.N., R.M.2 and J. ANDERTON, M.B., CH.B., F.R.C.ANAES.1

1Department of Anaesthesia, Central Delivery Suite, St. Mary's Hospital Hathersage Road, Whitworth Park, Manchester M13 9WL
2Department of Obstetrics, Central Delivery Suite, St. Mary's Hospital Hathersage Road, Whitworth Park, Manchester M13 9WL

*Address for correspondence: Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL.

Eighty normal primigravidae received an extradural dose of 0.25% bupivacaine and were then allocated randomly to receive "top-ups" of 0.25% bupivacaine (group A) or an infusion of 0.125% bupivacaine (group B). Group B received supplementary top-ups if required. Group A required more top-ups (147 vs 80) (? < 0.01). No maternal advantage was demonstrated from each regimen. Fetal state was assessed by analysis of the cardiotocograph during labour and the condition of the fetus at delivery. Three different patterns of late deceleratory episodes were identified (grades 1–3). Total numbers of episodes per group were similar (group A, 71; group B, 69). More episodes in group A were related to top-ups (42/71 vs 18/69; P < 0.07; but the incidence of episodes after a top-up was similar (group A, 42/147 (28.6%); group B, 18/80 (22.5%)). In group A. 31/42 events (73.8%) were transient compared with 11/18 persistent episodes (61.1 %) (< 10 min duration) in group B. However, the difference in the deceleratory patterns did not influence the condition of the fetuses at delivery.


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