Is opioid loading necessary before opioid/local anaesthetic epidural infusion?
The effects of two different epidural loading doses administered before starting an opioid/low dose local anaesthetic infusion were examined in a randomized double-blind study during labour. Forty mothers were given either 10 ml 0.25% plain bupivacaine or 10 ml 0.125% plain bupivacaine containing 5 mcg of sufentanil followed in all cases by epidural infusion of 0.08% plain bupivacaine containing 0.2 mcg/ml of sufentanil, which was continued into the second stage. The quality of analgesia did not differ significantly between the groups in either the first or the second stage of labour: in each group 75% of women required 0 or 1 top-up during labour and verbal numerical pain scores were similar. Over 80% of women in each group reported a pain free second stage of labour. There were no differences in the mode of delivery between the groups with 60% of women in each group having a spontaneous vaginal delivery. The proportion of women with motor block increased with the duration of the epid
