Comparison of standing stability with different doses in epidural fentanyl among post-cesarean delivery women: a prospective trial
The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery.
A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL-1 (Group 1, n = 8) or 5 mcg.mL-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups.
Participants’ demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm2, p < 0.05).
Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL-1 at 5 mL.h-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.
1 D. Buggy, N. Hughes, J. Gardiner Posterior column sensory impairment during ambulatory extradural analgesia in labour Br J Anaesth, 73 (1994), pp. 540-542
2 M.G. Parry, R. Fernando, G.P. Bawa, et al. Dorsal column function after epidural and spinal blockade: implications for the safety of walking following low-dose regional analgesia for labour Anaesthesia, 53 (1998), pp. 382-387
3 T.W. Breen, T. Shapiro, B. Glass, et al. Epidural anesthesia for labor in an ambulatory patient Anesth Analg, 77 (1993), pp. 919-924
4 L. Hauk American Academy of Family Physicians. Planning for Labor and Vaginal Birth After Cesarean Delivery: Guidelines from the AAFP Am Fam Physician, 91 (2015), pp. 197-198
5 A.C. Graham, J.H. McClure Quantitative assessment of motor block in labouring women receiving epidural analgesia Anaesthesia, 56 (2001), pp. 470-476
6 D. Song, F. Chung, J. Wong, et al. The assessment of postural stability after ambulatory anesthesia: a comparison of desflurane with propofol Anesth Analg, 94 (2002), pp. 60-64 table of contents
7 D. Moher, S. Hopewell, K.F. Schulz, et al. Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials J Clin Epidemiol, 63 (2010), pp. e1-37
8 J. Kim, W. Shin How to Do Random Allocation (Randomization) Clin Orthop Surg, 6 (2014), p. 103
9 H. Akabane, Y. Shimada, R. Ogawa Usefulness of posturography after epidural block J Nippon Med Sch, 71 (2004), pp. 35-43
10 D.J. Steward, G. Volgyesi Stabilometry: a new tool for the measurement of recovery following general anaesthesia for out-patients Can Anaesth Soc J, 25 (1978), pp. 4-6
11 A. Hiller, I. Pyykkö, L. Saarnivaara Evaluation of postural stability by computerised posturography following outpatient paediatric anaesthesia. Comparison of propofol/alfentanil/N2O anaesthesia with thiopentone/halothane/N2O anaesthesia Acta Anaesthesiol Scand, 37 (1993), pp. 556-561
12 C.D. Elton, P. Ali, M.C. Mushambi “Walking extradurals” in labour: a step forward? Br J Anaesth, 79 (1997), pp. 551-554
13 R.C. Etches, W.D. Writer, D. Ansley, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery Anesth Analg, 84 (1997), pp. 784-790
14 A. Opala-Berdzik, J.W. Błaszczyk, B. Bacik, et al. Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study PLoS One, 10 (2015), Article e0124207
15 J. McCrory, A. Chambers, A. Daftary, et al. Dynamic postural stability in pregnant fallers and non-fallers BJOG An Int J Obstet Gynaecol, 117 (2010), pp. 954-962
16 Y. Ginosar, E.T. Riley, M.S. Angst The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration Anesth Analg, 97 (2003), pp. 1428-1438
17 A.E. Pickering, M.G. Parry, B. Ousta, et al. Effect of combined spinal-epidural ambulatory labor analgesia on balance Anesthesiology, 91 (1999), pp. 436-441