A randomised double-blind comparison of epidural fentanyl versus fentanyl and bupivicaine for pain relief in the second stage of labour


Dr S. W. Lindow, Department of Obstetrics and Gynaecology, Women and Children's Hospital, Hull Royal Infirmary, The University of Hull, Anlaby Road, Kingston upon Hull, UK.


Objectives  To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour—fentanyl alone versus the usual mixture of bupivicaine and fentanyl.

Design  A double-blind, randomised, controlled trial.

Setting  An English maternity hospital.

Sample  Eighty nulliparous women in the second stage of labour.

Methods  After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl-only solution given at the same rate.

Main outcome measures  Mode of delivery, duration of the second stage and quality of analgesia.

Results  There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02–1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3–1.0).

Conclusion  Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.