Epidural Analgesia Compared with Combined Spinal–Epidural Analgesia during Labor in Nulliparous Women (original) (raw)
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Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia
American Journal of Obstetrics and Gynecology, 1997
Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women. STUDY DESIGN: Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted. RESULTS: One hundred women were randomized. No difference in the rate of cesarean delivery for dystocia was noted between the groups (epidural 8%, narcotic 6%; p = 0.71). No significant differences were noted in the lengths of the first (p = 0.54) or second (p = 0.55) stages of labor or in any other time variable. Women with epidural analgesia underwent operative vaginal delivery more frequently (p = 0,004). Pain scores were equivalent at randomization, but large differences existed at each hour t~qereafter. The number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unlikely to find a statistically significant difference in cesarean delivery rates in a trial of reasonable duration. CONCLUSIONS: With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia, (Am J There is controversy regarding the effect of epidural analgesia on the rate of cesarean birth for the indication of dystocia. Randomized trials 1' 2 have added credence to the impression of retrospective studies by Thorp et al)' 4 that there is an increased incidence of cesarean delivery for dystocia in women receiving epidural analgesia. A metaanalysis of studies comparing "epidural" with "no epiduraI" groups reached the conclusion that a 10% increase in the rate of cesarean delivery for the indication of dystocia is to be expected when epidural analgesia is provided. 5 On the other hand, the consensus among others appears to be that epidural analgesia has littIe, if
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women
American Journal of Obstetrics and Gynecology, 1989
Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. Comparison of 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia was performed. The incidence of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p < 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight. The incidence of cesarean section for fetal distress was similar (p > 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women. (AM J OBSTET
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.
Combined spinal–epidural analgesia in labour: its effects on delivery outcome
Brazilian Journal of Anesthesiology (English Edition), 2014
Background and objectives: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. Methods: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. Results: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. Conclusion: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.
Fetomaternal Outcome With and Without Combined Spinal- Epidural Analgesia in Normal Labour
The purpose of the study was to compare the maternal outcome in terms of duration of second stage of labour, mode of delivery and neonatal outcome in terms of Apgar score with and without the combined spinal-epidural (CSE) analgesia in normal labour.100 nullipara patients with singleton pregnancy, term gestation, and cephalic presentation, scheduled for normal vaginal delivery were divided into two groups A&B of 50 patients each. Group A received combined spinal-epidural analgesia at 3-5cm cervical dilatation as a method of pain relief with Levobupivacaine 2.5mg and Fentanyl 25µg while Group B didn't receive any analgesia. First stage, second stage, total duration of labourand mode of delivery were recorded in both groups. Patient satisfaction was assessed by interviewing the parturient after delivery. It was observed that total duration of labour remained same in both the groups while second stage of labour was slightly prolonged with analgesia. Also giving analgesia during labour neither increased the incidence of instrumental delivery nor cesarean section. None of the babies in both groups had Apgar score<7. Patient satisfaction was excellent.Thus it was concluded that CSE is an effective method of labour analgesia with no harmful effects on mother and fetus.
Journal of Anaesthesiology Clinical Pharmacology, 2021
Background and Aims: Dural puncture epidural (DPE) has been shown to improve labor analgesia over epidural (EPL), with fewer side effects than a combined spinal-epidural (CSE). However, there is some debate regarding the superiority of DPE over EPL and CSE. Therefore, we aimed to compare the effects of EPL, DPE, and CSE without intrathecal opioids on the epidural local anesthetic (LA) consumption and occurrence of side effects in early labor. Material and Methods: We randomly assigned parturient to one of the 3 groups; EPL, DPE, or CSE. EPL and DPE groups received a 10 mL loading dose of 0.1% bupivacaine with fentanyl 2 µg/mL. CSE group received intrathecal 2.5 mg bupivacaine (without opioids). Labor analgesia was maintained in all patients via patient-controlled epidural analgesia (PCEA). The primary outcome was the mean hourly consumption of epidural LA. Results: The mean hourly consumption of epidural LA anesthetic was significantly lower in CSE (9.55 mL), compared with the EPL (11 mL), and DPE (10.5 mL), P < 0.01; but no significant difference was seen between EPL and DPE. Compared with EPL and DPE, CSE achieved faster time to complete analgesia defined as a numeric rating pain scale (NRPS) ≤1 and sensory block, lower NRPS in the first hour and higher frequencies of complete analgesia. There were no differences between groups in terms of physician top-up boluses, the occurrence of side-effects, mode of delivery, Apgar scores, and maternal satisfaction. Conclusion: Compared with EPL and DPE, CSE without intrathecal opioids, had a less epidural LA consumption, faster onset of analgesia, with no difference in the incidence of side effects. Trial Registration: This study was registered at www.clinicaltrials.gov (NCT03980951).
Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
Brazilian Journal of Anesthesiology (English Edition)
Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02).
Epidural Analgesia During Childbirth
Saudi Journal of Internal Medicine
Background: Women worldwide may experience excruciating pain during childbirth. Epidural analgesia, sometimes used to relieve pain, has been endorsed as a safe and efficient procedure. The objective of this survey was to evaluate the attitude of women towards the use of epidural analgesia. Materials and Methods: Data was collected via interviews based on a standard questionnaire and analyzed using the latest version of SPSS. Results: The results indicate that the participants were knowledgeable about the use of epidural analgesia and thought it should be available in future deliveries and cesarean sections. Those with a history of pregnancy thought that pain was unnecessary and that epidural analgesia should be made available. Safety concerns were the primary reason women gave for not wanting to use epidural analgesia. Educational level, income, age and health insurance status influenced women’s opinions concerning epidural analgesia use during labor. The main source of information ...