Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: A meta-analysis

Abstract This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI‐FEN) and sufentanil (BUPI‐SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta‐analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I 2 index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI‐SUF and BUPI‐FEN administered mothers (mean difference [95%CI] of −33.55 [−74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of −0.61 [−1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score < 7 was significantly lower in BUPI‐FEN group (odd ratio [95%CI] of 0.31 [0.10, 0.95]; P < .05). Pruritus incidence was similar. In conclusion, BUPI‐FEN combination exhibits significantly better tolerability at an approximate ratio of 6 FEN:1 SUF, albeit, both fentanyl and sufentanil in combination with bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.