What is the recommended dose of fentanyl (Fentanyl) with hyperbaric bupivacaine (Bupivacaine)?

Recommended Fentanyl Dose with Hyperbaric Bupivacaine

For labor analgesia, use 15 µg fentanyl combined with 1.75 mg hyperbaric bupivacaine, as this represents the ED95 dose that provides reliable analgesia in 95% of patients. 1

Labor Analgesia Dosing

Initial bolus dosing should be 12.5-25 µg fentanyl with bupivacaine, with 15 µg being the optimal dose for reliable analgesia. 1

• At least 15 µg fentanyl is required to achieve reliable analgesia when combined with 2.5 mg bupivacaine 2, 1
• Doses below 15 µg may provide inadequate analgesia 1
• The combination of 1.75 mg bupivacaine with 15 µg fentanyl produces reliable analgesia in labor (ED95) 2, 1
• Doses of 5-25 µg all reduce local anesthetic requirements similarly, suggesting no benefit to exceeding 25 µg for initial dosing 1

For intrathecal catheter placement after inadvertent dural puncture, use 1.0-2.5 mg bupivacaine (0.1-0.25% concentration) with 12.5-25 µg fentanyl. 2

Cesarean Section Dosing

For cesarean delivery under spinal anesthesia, use 10-15 mg hyperbaric bupivacaine with 15-25 µg fentanyl to achieve predictable T4 sensory levels. 3

• The addition of 10 µg fentanyl allows reduction of bupivacaine dose from 12 mg to 8 mg while maintaining adequate surgical anesthesia 4
• Fentanyl doses of 12.5-15 µg with hyperbaric bupivacaine provide excellent intraoperative analgesia and prolonged postoperative analgesia (200-210 minutes) 5
• The clinical effect appears to reach a ceiling at 12.5 µg fentanyl 5
• Fentanyl 20 µg with hyperbaric bupivacaine provides adequate intraoperative analgesia without significant adverse effects 6

Important Clinical Considerations

Hyperbaric bupivacaine maintains its hyperbaric properties even with fentanyl addition, as the glucose content provides sufficient density to overcome the dilutional effect. 3

• The baricity of initial doses is rarely specified in published protocols, and most clinicians use plain (isobaric) bupivacaine solutions for labor analgesia via intrathecal catheters 2, 3
• Hyperbaric solutions are rarely used for initiating intrathecal catheter analgesia 2

Safety Monitoring Requirements

Implement frequent non-invasive blood pressure measurements for 30 minutes after intrathecal fentanyl administration. 1

• Continuous fetal heart rate monitoring for 30 minutes is required for obstetric patients 1
• Standard monitoring should continue thereafter per institutional protocol 1

Common Side Effects

Pruritus is the most common side effect but is typically mild. 5

• The incidence of shivering decreases significantly with fentanyl doses of 12.5-15 µg 5
• Nausea and pruritus occur more frequently with opioid addition but without significant clinical impact 6