Lower, variable intrathecal opioid doses, and the incidence of prolonged fetal heart rate decelerations after combined spinal epidural analgesia for labor: A quality improvement analysis

Patient demographics_ “n” is the number of subjects per group_ Values are mean (SD)_

	Intrathecal fentanyl dose (mcg)
	2.5	5	10	15	p-value
	(n=135)	(n=129)	(n=158)	(n=131)
Age; years	30 (6)	31 (6)	31(5)	30 (5)	0.25
BMI; kg.m-2	32 (7)	31 (7)	31 (6)	31 (6)	0.60
Gestational age; weeks	38 (4)	38 (4)	38 (3)	38 (2)	0.42

Labor and anesthetic variables_ Values are mean (95% CI) or number (proportion)_ “n” is the number of subjects per group_ “n” is the same for all rows except for row 2 “VAPS* difference before-CSE† minus after-CSE_”

		Intrathecal fentanyl dose (mcg)
	2.5	5	10	15
	(n=135)	(n=129)	(n=158)	(n=131)	p value
Oxytocin CSE administration prior to	47 (35%)	37 (29%)	52 (33%)	56 (43%)	0.18
VAPS difference before-CSE	5.3	5.6	5.3	6.7
minus after-CSE	(4.4–6.1)	(4.9–6.4)	(4.5–6.1)	(6.0–7.4)	0.07
	n=60	n=67	n=69	n=68
Use of nalbuphine	1 (0.7%)	4 (3.1%)	5 (3.1%)	7 (5.3%)	0.99
Use of diphenhydramine	1 (0.7%)	0	1 (0.6%)	0	0.99
Decrease in MAP‡ > 20% after CSE	50 (37%)	50 (39%)	62 (39%)	45 (34%)	0.24
Use of phenylephrine	3 (2.2%)	1 (0.8%)	4 (2.5%)	3 (2.3%)	0.83
Use of ephedrine	2 (1.5%)	2 (1.6%)	8 (5.0%)	1 (0.8%)	0.12
NRFHRC§	6 (4.4%)	3 (2.3%)	12 (7.6%)	4 (3.0%)	0.11
Use of nitroglycerine	1 (0.7%)	0	2 (1.3%)	0	0.49
Use of terbutaline	0	0	1 (0.6%)	0	0.61
Emergent minutes after cesarean CSE delivery 30	0	0	2 (1.3%)	0	0.25