The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial

Elisheva Fiszer, Boris Aptekman, Yuval Baar, Carolyn F. Weiniger

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Epidural fentanyl doses above 100 μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women. OBJECTIVE: To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography. DESIGN: A double-blinded randomised controlled study. SETTING: A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020. PATIENTS: Eighty labouring women with cervical dilation 5 cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus. INTERVENTIONS: Women randomised to high (>100 μg) or low (<100 μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2 h thereafter (T2  h). MAIN OUTCOME MEASURES: The primary outcome was CSA at T2  h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2  h. Sub-group analysis compared stomach content at T2  h according to baseline stomach content, empty (CSA <381 mm2) or full (CSA ≥381 mm2), and high-dose versus low-dose fentanyl. RESULTS: Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no significant difference in CSA at T2  h between high-dose, mean 335 ± SD 133 mm2, versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2  h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically significant differences in CSA at T2  h. CONCLUSION: The CSA at T2  h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort. TRIAL REGISTRATION: Clinicaltrials.gov number: NCT04202887.

Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalEuropean Journal of Anaesthesiology
Volume39
Issue number1
DOIs
StatePublished - 1 Jan 2022

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