Comparision of efficacy of sufentanil and fentanyl with low-concentration bupivacaine for combined spinal epidural labour analgesia

Objectives: The highly lipid-soluble opioids, sufentanil and fentanyl, are used in combination with low-concentration bupivacaine to provide combined spinal epidural (CSE) analgesia during labour. We designed a prospective, randomized, single-blind study to compare the efficacy of these two opioids with bupivacaine in terms of the quality of analgesia, side-effects and maternal and foetal outcome. Methods: Sixty parturients requesting labour analgesia were divided into two groups randomly. Group S (n=30) received bupivacaine heavy (2.5 mg) and sufentanil (5 mcg) intrathecally and 10 mL intermittent bolus of sufentanil 0.30 mcg/mL in bupivacaine 0.125% as epidural top-ups. Group F (n=30) received bupivacaine heavy (2.5 mg) and fentanyl (25 mcg) intrathecally and 10 mL intermittent bolus of fentanyl 2.5 mcg/mL in bupivacaine 0.125% as epidural top-ups. Duration of intrathecal and epidural analgesia, mean duration between epidural top-ups and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with a 10-point visual scale. Mode of delivery and neonatal Apgar scores were recorded. Results: Maternal demographic characteristics were comparable between the groups. Although CSE provided satisfactory analgesia in both the groups, parturients of group S had a significant prolongation of analgesia through the intrathecal route compared with parturients of group F. Incidence of caesarean, instrumental delivery did not differ between the groups. No difference in the incidence of motor blockade or cephalad extent of sensory analgesia was observed. Neonatal outcome and incidence of side-effects were similar in both the groups. Conclusion: We conclude that combined spinal epidural using sufentanil and fentanyl achieved high patient satisfaction and excellent labour analgesia without serious maternal or neonatal side-effects. Sufentanil provided a significantly longer duration of labour analgesia compared with fentanyl

Comparison of interlaminar and transforaminal epidural steroid injection for lumbosacral radiculopathy: A prospective randomized interventional study

Background: Low back pain due to Intervertebral disc herniation, intervertebral disc degeneration without disc herniation are the most common diagnosis of chronic persistent low back and lower extremity symptoms. Epidural steroid injections (ESI) are one of the most common interventional techniques for managing low back pain with or without lower extremity radiation Aims and objectives: Comparison of the effectiveness of lumbar Interlaminar and Transforaminal epidural steroid injections in managing various types of chronic low back pain. Material and methods: A total of 60 patients with history of lumbosacral radicular pain (≥3 months with VAS score ≥50) and magnetic resonance imaging (MRI) of the lumbar spine showing the exact disc level protrusion, who met the inclusion criteria were selected. With simple purposive sampling techniques, all patients were randomly divided into two groups. Group I Received 4 ml of 0.25% bupivacaine with 8mg dexamethasone through fluoroscopy guided interlaminar epidural route  and Group T Received 2ml of 0.25% bupivacaine with 4mg dexamethasone through transforaminal route. Baseline assessment was completed just before the randomization and then follow up SLRT and VAS score recordings were taken - post 1 week, 1 month and 3 months after the procedure.