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Single-dose intrathecal analgesia to control labour pain

Is it a useful alternative to epidural analgesia?

Len Kelly, MD MClinSc CCFP FCFP
Associate Professor of Family Medicine at the Northern Ontario School of Medicine and McMaster University in Sioux Lookout

Alana Minty
First-year pharmacy student at the University of Toronto in Ontario

D.C. Hammett, MD CCFP FRACGP
Assistant Professor at the Northern Ontario School of Medicine in Sioux Lookout

Correspondence to: Dr R. Minty, Box 489, Sioux Lookout, ON P8T 1A8; e-mail rminty{at}gosiouxlookout.com

OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour.

QUALITY OF EVIDENCE MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence.

MAIN MESSAGE The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantageof single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 µg of fentanyl, and 250 µg of morphine intrathecally usually provides a 4-hour window of acceptable analgesia for patients without complications not anticipating protracted labour. The evolution in dosing of ITN warrants a re-examination of its usefulness in modern obstetric practice.

CONCLUSION Physicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.

This article has been cited by other articles:

				M. A. Duncan Labour pains Can Fam Physician, January 1, 2008; 54(1): 28 - 29. [Full Text] [PDF]

				P. Dopp ITN requires training Can Fam Physician, June 1, 2007; 53(6): 1003 - 1004. [Full Text] [PDF]