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British Journal of Anaesthesia, 2001, Vol. 86, No. 4 567-569
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Choice of opioid for initiation of combined spinal epidural analgesia in labour—fentanyl or diamorphine

D. J. A. Vaughan, N. Ahmad, N. K. Lillywhite, N. Lewis, D. Thomas and P. N. Robinson

Department of Anaesthesia, Northwick Park and St Marks NHS Trust, Watford Road, Harrow, Middlesex HA1 3AJ, UK*Corresponding author

Sixty-two women requesting regional analgesia in labour were allocated to receive a 1.5 ml intrathecal injection as part of a combined spinal–epidural (CSE) analgesic technique. This contained either bupivacaine 2.5 mg plus fentanyl 25 µg (group F) or bupivacaine 2.5 mg plus diamorphine 250 µg (group D). Times of analgesic onset and offset were recorded, motor and proprioceptive assessments made and side-effects noted. Analgesic onset was not significantly different between the groups (group F, 8.0 min; group D, 9.5 min; P=0.3) but time to first top-up request was significantly longer in the diamorphine group (group F, 73 min; group D, 101 min; P=0.003). Motor loss, assessed by the modified Bromage score, was statistically but not clinically greater in the fentanyl group (P=0.01). Maternal hypotension, pruritis, proprioceptive loss, nausea and fetal bradycardia were rare and not severe, and their incidences did not differ between groups. No respiratory depression was observed after CSE. This use of diamorphine was not associated with increased side-effects compared with fentanyl/bupivacaine, and it has a longer duration of action.

Br J Anaesth 2001; 86: 567–9


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G. A. McLeod, B. Munishankar, and M. O. Columb
Is the clinical efficacy of epidural diamorphine concentration-dependent when used as analgesia for labour?
Br. J. Anaesth., February 1, 2005; 94(2): 229 - 233.
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