Table 2.

Common dosing regimens for neuraxial analgesia in labour. In Europe, levobupivacaine (not available in the USA) may be substituted for bupivacaine at comparable doses. DPE, dural puncture epidural; PCEA, patient-controlled epidural analgesia; PIEB, programmed intermittent epidural bolus

Labour spinal dosing
Local anaesthetic	Opioid
Bupivacaine 2.5 μg	Fentanyl 10–15 μg
Ropivacaine 2.5–3.5 μg	Sufentanil 1.5–5 μg
Epidural (DPE) loading dose
Local anaesthestic	Opioid
10–15 ml bupivacaine 0.125%	Fentanyl 50–100 μg (50 μg probably enough)
10–15 ml ropivacaine 0.2%	Sufentanil 10 μg
Epidural infusion (10–15 ml h−1)
Bupivacaine 0.0625–0.125% with fentanyl 2 μg ml−1 or sufentanil 0.2–0.5 μg ml−1
Ropivacaine 0.10–0.20% with fentanyl 2 μg ml−1 or sufentanil 0.2–0.5 μg ml−1
PCEA recipes (patient-controlled epidural analgesia)
4–6 ml of infusion drug, lockout 5–10 min, maximum 30–35 ml h−1 total infusion plus boluses
PIEB strategy (essentially replace 10–12 ml h−1 infusion with timed bolus, similar hourly dose, usually with additional PCEA doses)
6–8 ml q 30 min
9–10 ml q 45 min
12 ml q 60 min