Drugs used for neuraxial labor analgesia

	Epidural	Spinal
Local anesthetic
Bupivacaine	0.0625 to 0.1%	2.5 to 5 mg alone 1.25 to 3 mg with opioid
Ropivacaine	0.08 to 0.1%	3 to 4 mg alone 1.25 to 3 mg with opioid
Opioid
Fentanyl	1 to 3 mcg/mL	15 to 25 mcg alone 10 to 15 mcg with LA
Sufentanil	0.2 to 0.5 mcg/mL	5 to 8 mcg alone 2.5 to 5 mcg with LA

This table shows a range of drugs used for neuraxial labor analgesia. There is substantial variation in clinical practice.

For CSE:

For CSE with a low dose of intrathecal local anesthetic or intrathecal opioid only, analgesia can then be initiated with a bolus of 10 to 20 mL of a combination of an LA with or without a 3-mL lidocaine with epinephrine test dose and an opioid (eg, fentanyl or sufentanil) if not given intrathecally.
For CSE with the higher intrathecal doses shown above, epidural analgesia may be initiated without an epidural bolus.
Epidural analgesia is then maintained with the same or a more dilute solution, administered by infusion and patient-controlled epidural analgesia.

Epidural analgesia is initiated with a bolus of 10 to 20 mL of a combination of an LA (either bupivacaine or ropivacaine, with or without a 3-mL lidocaine with epinephrine test dose) and an opioid (either fentanyl or sufentanil). Epidural analgesia is maintained with the same or a more dilute solution, administered by infusion and patient-controlled epidural analgesia.

LA: local anesthetic; CSE: combined spinal epidural.

Graphic 108412 Version 5.0

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Drugs used for neuraxial labor analgesia