To the Editor:- In the July 1997 issue of Anesthesiology, Robert D'Angelo and James C. Eisenach reported severe maternal hypotension (74/38 mmHg) and fetal bradycardia four minutes after intrathecal injection of 2.5 mg bupivacaine and 7.5 [micro sign]g sufentanil. The authors warned the reader of the pitfalls of the combined spinal epidural technique. However, we believe that the problem is more likely related to excessive doses of the injected drugs and not to the technique.

In 1995, we showed, in an audit of 620 parturient patients, that intrathecal administration of 1 mg bupivacaine with 5 [micro sign]g sufentanil epinephrine resulted in excellent analgesia in 94% of all parturient patients. [1]Motor block was not a problem. Hypotension with a systolic pressure less than 100 mmHg occurred in 24 patients (4%) but was always easily corrected, either by positioning of the mother or, in two cases, by administration of intravenous ephedrine (5 mg). Currently, we have experience with this dosage in more than 3,500 patients. Analgesia is excellent, and severe and lasting hypotension is of no concern.

We are convinced that the administration of 2.5 mg bupivacaine and 7.5 [micro sign]g sufentanil is the real mischief and not the technique as such.

Stephane Joos, M.D.

Department of Anesthesiology; Clinique Axium; Aix en Provence, France

Albert Van Steenberge, M.D.

Department of Anesthesia; Vliertjeslaan, Overijse, Belgium

(Accepted for publication April 8, 1998.)

Joos, S, Servais R, Van Steenberge A: Sequential spinal epidural analgesia for pain relief in labor. Int J Obstet Anesth 1995;3:155-7