Combined spinal-epidural analgesia and epidural analgesia induced maternal fever with a similar timing during labor-A randomized controlled clinical trial

Abstract

BackgroundBoth epidural and combined spinal-epidural (EA and CSEA) analgesia can induce intrapartum maternal fever. CSEA has a more rapid onset and wider nerve block than EA. Therefore, CSEA might have a different profile of intrapartum maternal fever, including higher temperatures or earlier occurrence. This randomized clinical trial was to determine whether CSEA could cause maternal fever earlier than EA.MethodsA randomized, double-blind, controlled clinical trial was performed on 233 nulliparous full-term pregnant women during vaginal delivery. The pregnant women were randomly allocated into the EA group (n = 113) and the CSEA group (n = 120). The fever latent period, from analgesia start to fever occurrence, was the primary endpoint in this study. The temperature was measured every 30 min using an eardrum thermometer during labor analgesia. The fever was defined as an eardrum temperature of ≥38 °C.ResultsNo difference was found in the maternal fever rate between the EA and the CSEA groups (10/113 vs. 7/120, P = 0.356). There was no significant difference in the fever latent period between the two groups (4.75 ± 0.86 h vs. 3.79 ± 2.2 h, p = 0.305). The temperatures at all points had no differences between EA and CSEA.ConclusionCSEA had a similar latent fever period as EA. A further study is warranted to confirm the similar characteristic between CSEA and EA in the development of intrapartum maternal fever.Clinical trial registrationwww.chictr.org.cn, identifier ChiCTR2000038793.

Effects of different neuraxial analgesia modalities on the need for physician interventions in labour

“…After removing duplicates and screening titles and abstracts, 191 studies were potentially relevant, and the full texts were examined. Finally, 30 studies, 24–53 comprising 8188 healthy labouring women, were included in the NMA (Fig. 1).…”

“…Sixteen studies used a multiorifice epidural catheter, [24][25][26][27]32,35,38,[41][42][43][44][45][46]50,51,53 three studies used a single-orifice epidural catheter, 28,34,48 while others did not specify the catheter type. The overall risk of bias was low for 13 (43%) studies, [24][25][26][27][28]34,35,38,40,41,44,45,48 some concerns for 11 (37%) Reports of included studies (n = 30) Included Eur J Anaesthesiol 2024; 41:411-420 studies, [29][30][31][32][33]42,43,47,[50][51][52] and high for six (20%) studies 36,37,39,46,49,53 (Supplementary Digital Content 3, Fig.…”

“…Local anaesthetics consumption was reported by 24 studies, [24][25][26][29][30][31][32][33][34][35][36][37][38][39][40][41][42][44][45][46]48,[51][52][53] including 6943 women. Compared with EPLþCEIþPCEA, DPEþPIEBþPCEA had a lower hourly local anaesthetics consumption, but the difference was slight: The MD (95% CrI) was -1.5 (-2.8 to -0.3) mg h À1 bupivacaine equivalent.…”

“…The incidence of instrumental delivery was reported by 27 studies, [24][25][26][27][28][29][30][31][32][34][35][36]38,39,[41][42][43][44][45][46][47][48][49][50][51][52][53] including 7752 women. No significant differences in this outcome were found in all comparisons, except for DPEþCEIþPCEA vs. CSEþPIEBþPCEA (OR ¼ 3.06; 95% CrI, 1.13 to 7.96) (Table 2).…”