Abstract
We tested the hypothesis that the sedative, euphoric, and analgesic effects of intravenous fentanyl would distinguish intravenous from epidural administration. One hundred ASA I and II labouring parturients received 100 μg fentanyl either iv or via an epidural catheter in a double-blind, randomized, crossover fashion. Nineteen anaesthetists (8 staff and 11 residents) participated and correctly guessed the route of administration of the fentanyl in 61/66 intravenous doses and in 69/75 epidural doses yielding a sensitivity of 92.4%, a specificity of 92.0%, a positive predictive value of 91.0%, and a negative predictive value of 93.2%. Of the 41 patients that were crossed over, 38 (92.7%) were able to detect a difference between the routes of administration. Most patients experienced prompt, short-lived symptoms with iv fentanyl but no important differences in fetal heart rate pattern or in maternal desaturation were seen between the groups. This study suggests that subjective symptoms will accurately distinguish intravenous from epidural fentanyl administration in labouring parturients (P < 0.001), and should serve as a safe and reliable intravenous test dose for epidural anaesthesia in the obstetric population.
Résumé
Nous avons vérifié l’hypothèse selon laquelle les effets sédatifs, euphorisants et analgésiques du fentanyl intraveineux différencieraient l’administration intraveineuse de l’épidurale. Cent parturientes en travail ASA I et II ont reçu du fentanyl 100 μg soit par la voie veineuse, soit par un cathéter épidural, au hasard et en test croisé à double inconnue. Dix-neuf anesthésistes (huit patrons et onze résidents) ont participé à l’étude et ont identifié correctement la voie d’administration du fentanyl dans 61 sur 66 doses intraveineuses et dans 69 sur 75 doses épidurales produisant une sensibilité de 92,4%, une spécificité de 92,0%, une valeur prédictive positive de 91,0% et une valeur prédictive négative de 93,2%. Des 41 patientes en croisement, 83 (92,7%) ont été capables de déceler la différence entre les voies d’administration. La plupart des patientes ont éprouvé des symptômes immédiats et de courte durée avec le fentanyl iv mais nous n’avons pas constaté de différences sur le tracé de la fréquence foetale et pour le degré de désaturation maternelle entre les groupes. Cette étude porte à croire que les symptômes subjectifs permettent de distinguer avec précision l’administration intraveineuse de l’administration épidurale chez les patientes en travail (P < 0,001) et devrait servir de dose-test fiable et sans danger pour l’anesthésie épidurale de la parturiente.
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Morris, G.F., Gore-Hickman, W., Lang, S.A. et al. Can parturients distinguish between intravenous and epidural fentanyl?. Can J Anaesth 41, 667–672 (1994). https://doi.org/10.1007/BF03015618
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DOI: https://doi.org/10.1007/BF03015618