Epidural analgesia for labor: Current techniques (original) (raw)
Related papers
The effects of epidural analgesia in normal labor
IP Innovative Publication Pvt. Ltd. , 2018
Introduction: Labor pain is the most severe pain a women would experience and several treatment modalities have been adopted since decades. Labor analgesia using epidural technique is considered as the efficient and effective treatment options available. Parturients in India especially rural areas are less aware regarding labor analgesia using epidural technique. Aim: To study the effects of labor analgesia using epidural technique in nulliparous women. Materials and Methods: Sixty full term nulliparous women with singleton vertex pregnancy were made aware of labor analgesia using epidural technique and included, those willing were grouped epidural(n=30), those not keen were grouped control(n=30). In 1 st stage labor, parturients in epidural group received bupivacaine and fentanyl, whereas in control group received intramuscular Inj. tramadol, and Inj. pethidine if needed. Duration of 1 st and 2 nd stage labor, pain relief, maternal satisfaction, adverse effects, instrumental deliveries, 1 st and 5 th minute Apgar score and NICU admission were recorded. Results: The mean duration of first stage labor was shorter (p=0.071) in epidural group (250.17±106.33 minutes) compared with control group (302.0±111.99 minutes) and statistically insignificant prolongation (p=0.892) (18.73±6.82 minutes) of 2 nd stage labor as compared to control (18.33±14.53 minutes). Pain relief in epidural group was statistically significant (p<0.001). Instrumental delivery rate although higher in epidural group was statistically insignificant (p=1.00). The Apgar score at 1 st (p=0.306) and 5 th minutes (p=1.00), NICU admission rate were statistically insignificant (p=0.143) between groups. Conclusion: Labor epidural analgesia using Inj.bupivacaine and Inj.fentanyl provides good pain relief, safe for mother and baby. It does not affect labor duration, instrumental delivery rate or neonatal outcome. Keywords: Labor analgesia, Epidural, Bupivacaine, Fentanyl, Labor stages, Apgar score, NICU admission.
Current practice of epidural analgesia during normal labour
Anaesthesia, 2007
A postal survqy of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivicaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top-up9 whereas 0.25% was most often used during thejirst stage of labour. Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
Epidural analgesia during labor vs no analgesia: A comparative study
Saudi Journal of Anaesthesia, 2012
Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. this study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: one hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 ml bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal apgar score were recorded. Results: there was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.
Regional Anesthesia and Pain Medicine, 2017
Background and Objectives: The effectiveness of labor epidural analgesia is difficult to explore, as it includes the maternal satisfaction with analgesia as well as the overall childbirth experience. In this populationbased study, we sought to identify factors associated with the effectiveness of epidural analgesia for labor pain relief. Methods: We performed a secondary analysis of the 2010 French National Perinatal Survey, a cross-sectional study of a representative sample of births in France. All participants who gave birth with an epidural analgesia were included. Effectiveness of epidural analgesia was assessed 2 to 3 days after delivery and intended to include analgesic efficacy and maternal satisfaction together. The factors analyzed were anesthetic management and maternal, obstetrical, and organizational characteristics, using a logistic regression with random effects model.
Obstetric Practice and Epidural Analgesia
BJOG: An International Journal of Obstetrics and Gynaecology, 1970
The problems of introducing epidural analgesia into the labour wards are discussed and the results of a double blind trial of 1 per cent lignocaine and 0.25 per cent bupivicaine are presented. The trial included 84 patients having continuous caudal analgesia. Bupivicaine was the more satisfactory analgesic agent. Epidural analgesia has a definite part in obstetric management as well as being a safe and efficient method of pain relief in labour.
Efficacy and Safety of Epidural Analgesia versus Traditional Analgesia for Relief of Labour Pain
KYAMC Journal
Background: Labour pain, a form of acute pain, intensity of the pain is perceived by many women as very severe or intolerable especially in nulliparous. Providing effective and safe analgesia during labour has remained an ongoing challenge. Multiple pharmacologic and non-pharmacologic options are available to manage labour pain. Epidural analgesia have reported nearly complete pain relief with effective labour conduction. Objective: Purpose of this study was to evaluate the effectiveness of epidural analgesia and pethidine during labour and delivery. Materials & Methods: This cross sectional comparative study was conducted to compare the efficacy and safety between epidural and traditional analgesia on nulliparous women in labour. Subjects were grouped into two, group A received epidural & group B received traditional analgesia, each group comprising with 40 patients. Then the subjects were followed up and outcomes were recorded in a preformed data collection sheet. Results: The two...
Comparison of combined spinal-epidural and low dose epidural for labour analgesia
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2000
Purpose: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour. Methods: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, doubleblind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n=24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local anesthetic sodium bicarbonate 8.4% and epinephrine 1:200, 000. The CSE group (n=26) received intrathecal 25 µg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request. Results: There were no differences (P > 0.05) in time to perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes < three: 26/26 vs 17/24, P ± 0.001). Conclusion: Although epidural analgesia with a low concentration of local anesthetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE. Objectif : Comparer l'analgésie rachidienne-péridurale combinée (RPC) à l'analgésie péridurale concernant le temps nécessaire à la réalisation de la technique et à l'induction, le blocage moteur, le délai d'installation de l'analgésie et la satisfaction de la patiente pendant le travail obstétrical. Méthode : Au moment de la demande d'analgésie, 50 parturientes à terme réparties de façon aléatoire ont reçu soit une analgésie RPC, soit une analgésie péridurale lombaire pour participer à une étude prospective en double insu. Le groupe péridural (n=24) a reçu un mélange bupivacaïne 0,0625 %-fentanyl 0,0002 % avec un ajout de 0,05 ml (par 10 ml d'anesthésique local) de bicarbonate de sodium à 8,4 % et de l'épinéphrine 1:200 000. Le groupe RPC (n=26) a reçu une injection intrathécale de 25 µg de fentanyl et de 2,5 mg de bupivacaïne. L'analgésie supplémentaire a été administrée sur demande. Résultats : Il n'y a eu aucune différence intergroupe (P > 0,05) quant au temps nécessaire à la réalisation de chacune des techniques et à l'atteinte du blocage moteur, à la satisfaction des patientes et au nombre d'interventions de l'anesthésiologiste appelé sur demande. Le premier signe d'analgésie est survenu au même temps dans les deux groupes, mais le début de l'analgésie complète est survenu plus rapidement dans le groupe RPC (Score à l'Échelle Visuelle Analogique, SEVA, à cinq minutes < trois : 26/26 vs 17/24, P ± 0,001). Conclusion : L'analgésie péridurale complète réalisée avec une faible concentration d'anesthésique local et un mélange d'opioïdes connaît une installation plus lente que l'analgésie RPC, mais elle en constitue une solution de remplacement satisfaisante.
Comparative Study of the Effect of Early Versus Late Initiation of Epidural Analgesia on Labour
International journal of Gynecology, Obstetrics and Neonatal Care, 2015
Background: Epidural analgesia also known as regional analgesia has been established as a safe and an effective method of pain relief during labor. It was thought that epidurals may possibly interfere with labor and consequently increase the rate of cesarean deliveries or instrumental deliveries or other adverse effect.. A more recent review concluded that epidural analgesia is not associated with such a risk. But, the timing of placement of epidural analgesia has been a controversial issue and how early laboring women can benefit from epidural analgesia is still debated. Hence this comparative study determines the effect of early versus late initiation of epidural analgesia on labor. Objective: To compare the effect of early versus late initiation of epidural analgesia on the duration of labour and the mode of delivery. Methodology: A randomized trial in which 100 term women in early labor at less than3 cm of cervical dilatation were assigned to either immediate initiation of epidural analgesia at first request (50 women) or delay of epidural until the cervix was dilated to at least 4 cm (50 women). Results: At initiation of the epidural, the mean cervical dilatation was 3.1 cm in the early epidural group and 4.4 cm in the late group (P value 0.0000). The mean duration from initiation to full dilatation was significantly shorter in the early compared to the late epidural group: 5.57 hours and 6.3hours respectively amongst primigravida (P = 0.0001) and 3.04 hours and 4.07 hours respectively amongst multigravida. The rates of cesarean section were not significantly different between the groups i.e. 6% and 6% in both early and late groups (P = 0.82) which was not significant. When questioned after delivery regarding their next labor, the women indicated a preference for early epidural. Conclusion: Epidural analgesia in the early labour, following the first request for epidural at cervical dilation of 2-3 cm does not prolong the progression of labor and does not increase the rate of Cesarean deliveries , instrumental vaginal deliveries , and other adverse effects in laboring women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more. Furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.