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Epidural infusion of alfentanil or diamorphine with bupivacaine in labour—a dose finding study

Following induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8ml.h‐1 of0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400μg.h‐1 (groups A1‐A3) or with diamorphine at 133, 266, 400 or 533μg.h1 (groups D1‐D4). Significantly longer top‐up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p<0.01), making the minimum effective doses 266 μg.h‐1 of alfentanil and 400 ng.h‐1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side‐effects were demonstrated.