Combined spinal-epidural versus epidural analgesia in labour

Simmons, S. W.; Taghizadeh, Neda; Dennis, A.T.; Hughes, David C.; Cyna, Allan M

doi:10.1002/14651858.cd003401.pub3

Cited by 202 publications

(187 citation statements)

References 73 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…It is noteworthy that our study showed no hemodynamic differences between the two groups but faster reduction of NRS values in CSEA group at 15 min when exposed to two equianalgesic regimens; this may suggest an additional advantage for CSEA, as it would provide faster and better analgesia at the first stage of labour with no added hemodynamic repercussions. In line with our results, a recent Cochrane Review that compared CSEA and EA involving 3274 women found no difference in maternal hypotension whereas a more rapid onset of analgesia in the CSEA group [21]. Also, we found no significant differences between the two groups regarding urinary retention and rates of operative or instrumental deliveries.…”

Section: Discussionsupporting

confidence: 91%

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Gallardo¹,

Meneghetti²,

Ripa³

et al. 2017

SOJPPS

View full text Add to dashboard Cite

Background: Combined spinal epidural analgesia (CSEA) has become a widespread technique in obstetric analgesia. Sufentanil is currently widely used in combination with a low concentration of local anaesthetic to reduce both motor block and local anesthetic requirements. While some studies have reported on the hemodinamic changes after the intrathecal administration of sufentanil in the early phase of labor, no randomized controlled trials have been performed. We compared hemodynamic impact, quality of the analgesia, safety, side effects and impact on labor and delivery after the administration of two equipotent doses of sufentanil given by intrathecal versus epidural route.

show abstract

Section: Discussionsupporting

confidence: 91%

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Gallardo¹,

Meneghetti²,

Ripa³

et al. 2017

SOJPPS

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Nevertheless, labour epidural analgesia may be associated with side effects, including prolonged labour, increased incidence of assisted vaginal delivery (AVD), 4,5 reduced ability to ambulate, 6 pruritus, 7 hypotension, 8 requirement for urinary catheterization, 9 and abnormal fetal heart rate. 10 Limiting the dose of local anesthetic and use of adjuvant drugs, such as opioids and epinephrine, may potentially reduce these side effects.…”

Section: Résumémentioning

confidence: 99%

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Sultan

Murphy

Halpern

et al. 2013

Can J Anesth/J Can Anesth

120

View full text Add to dashboard Cite

Introduction The influence that different concentrations of labour epidural local anesthetic have on assisted vaginal delivery (AVD) and many obstetric outcomes and side effects is uncertain. The purpose of this meta-analysis was to determine whether local anesthetics utilized at low concentrations (LCs) during labour are associated with a decreased incidence of AVD when compared with high concentrations (HCs). Methods We searched PubMed, Ovid EMBASE, Ovid MEDLINE, CINAHL, Scopus, clinicaltrials.gov, and Cochrane databases for randomized controlled trials of labouring patients that compared LCs (defined as B 0.1% epidural bupivacaine or B 0.17% ropivacaine) of epidural local anesthetic with HCs for maintenance of analgesia. The primary outcome was AVD and secondary outcomes included Cesarean delivery, duration of labour, analgesia, side effects (nausea and vomiting, motor block, hypotension, pruritus, and urinary retention), and neonatal outcomes. The odds ratios (OR) or weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated using random effects modelling. An OR \ 1 or a WMD \ 0 favoured LCs. Results Eleven studies met our criteria (eight bupivacaine and three ropivacaine studies), providing 1,145 patients in the LCs group and 852 patients in the HCs group for analysis of the primary outcome. Low concentrations were associated with a reduction in the incidence of AVD (OR = 0.70; 95% CI 0.56 to 0.86; P \ 0.001). There was no difference in the incidence of Cesarean delivery (OR 1.05; 95% CI 0.82 to 1.33; P = 0.7). The LCs group had less motor block (OR 3.9; 95% CI 1.59 to 9.55; P = 0.003), greater ambulation (OR 2.8; 95% CI 1.1 to 7.14; P = 0.03), less urinary retention (OR 0.42; 95% CI 0.23 to 0.73; P = 0.002), and a shorter second stage of labour (WMD -14.03; 95% CI -27.52 to -0.55; P = 0.04) compared with the HCs group. There were no differences between groups in pain scores, maternal nausea and vomiting, hypotension, fetal heart rate abnormalities, five-minute Apgar scores, and need for neonatal resuscitation. One-minute Apgar scores \ 7 favoured the HCs group (OR 1.53; 95% CI 1.07 to 2.21; P = 0.02), and there was more pruritus in the LCs group (OR 3.36; 95% CI 1.00 to 11.31; P = 0.05). Conclusion When compared with HCs of local anesthetics, the use of LCs for labour epidural analgesia reduces the incidence of AVD. This may be due to a Author contributions Pervez Sultan, Caitriona Murphy, Stephen Halpern, and Brendan Carvalho made substantial contributions to the conception and design of the study and were involved in drafting the article for important intellectual content. -013-9981-z reduction in the amount of local anesthetic used and the subsequent decrease in motor blockade. We therefore recommend the use of LCs of local anesthetics for epidural analgesia to optimize obstetric outcome.123 Can J Anesth/J Can Anesth (2013) 60:840-854 DOI 10.1007/s12630 RésuméObjectif Nous connaissons mal l'influence de différentes concentrations d'anesthésique local pour la péridurale...

show abstract

“…19,20 Geliştirilmiş tekniklerle birlikte birçok araştırmacı, dilüe anestezik solüsyonların epidural yolla uygulanmasının sezaryen oranında artışa yol açmadığını bildirmişlerdir. 21 Sharmo ve ark. 14 randomize çalışmanın meta-analizinde epidural analjezinin artmış sezaryen oranı ile ilişkili olmadığını göstermişlerdir.…”

Section: Discussionunclassified

Effects of Epidural Analgesia on Labor, Delivery and Neonatal Outcomes in Patients Performed Epidural Analgesia During Labor

Gümüş¹,

Melekoğlu²,

Evrüke³

et al. 2015

Turkiye Klinikleri J Gynecol Obst

View full text Add to dashboard Cite

146Doğum Eylemi Sırasında Epidural Analjezi Uygulanmış Hastalarda Epidural Analjezinin Doğum Eylemi, Doğum ve Neonatal Sonuçlara Etkisi Ö ÖZ ZE ET T A Am ma aç ç: : Doğum eylemi sırasında epidural analjezi uygulanmış hastalarda, epidural analjezinin doğum eylemi, doğum ve neonatal sonuçlara etkilerinin değerlendirilmesi amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çukurova Üni-versitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğine 1 Ocak 2013-31 Aralık 2013 tarihleri arasında başvuran, doğum eylemi spontan başlamış, çalışmanın katılım kriterlerini karşılayan 106 gebe çalışmaya dâhil edildi. Aynı özelliklere sahip epidural analjezi işlemini kabul etmeyen 251 gebe de kontrol grubu olarak alındı. Gruplar demografik özellikleri, obstetrik sonuçları ve neonatal sonuçları açısından karşılaştırıldı. Sonuçlar arasında istatistiksel önem düzeyi için p değeri <0,05 olarak alındı. B Bu ul lg gu ul la ar r: : Yaş, beden kitle indeksi, gebelik haftası ve doğumhaneye yatışları sırasındaki servikal dilatasyonları açısından gruplar arasında anlamlı fark izlenmedi. Epidural analjezi uygulanan hastaların doğumun birinci ve ikinci evresinin anlamlı oranda uzun (p=0,001), normal doğum oranının anlamlı oranda fazla, epizyotomi ihtiyacının anlamlı düzeyde fazla (p=0,000), operatif doğum oranının ise anlamlı düzeyde az olduğu saptandı (p=0,009). Plasenta retansiyonu görülmesi açısından gruplar arasında anlamlı fark izlenmedi (p=0,158). Neonatal sonuçlar açısından karşılaştırıldığında ise gruplar arasında doğum kiloları, 1. ve 5. dakika APGAR skorları açısından anlamlı fark saptanmaz iken, epidural analjezi uygulanmış annelerin bebeklerinde yenidoğan yoğun bakıma yatış oranları anlamlı düzeyde yüksek saptandı (p=0,001). S So on nu uç ç: : Çalışmamızda doğum eylemi sırasında epidural analjezi kullanımının operatif doğum ve sezaryen oranlarını artır-madığı, yenidoğanlarda yenidoğan yoğun bakım ünitesine yatış oranlarında artış olduğu saptansa da 1. ve 5. dakika APGAR skorları arasında çalışma ve kontrol grubu arasında anlamlı fark olmadığı gösterilmiştir. Bu sonuçlar ışı-ğında çalışmamız, epidural analjezi ile normal doğumun hasta konforu açısından avantajlı bir yöntem olması yanı sıra hem anne hem bebek açısından güvenli ve seçkin bir yöntem olduğunu ortaya koymuştur.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Analjezi, epidural; normal doğum; gebelik sonucu A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this study, it is aimed to evaluate the effects of epidural analgesia on labor, delivery and neonatal outcomes in patients performed epidural analgesia during labor. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : All patients admitted to Çukurova University Medical Faculty Hospital, Obstetrics and Gynecology Clinic because of the onset of labor spontaneously between 1 January 2013-31 December 2013 were included in the study. A total of 106 pregnant women that meet the inclusion criteria were enrolled in the study group. 251 pregnant women with the same chara...

show abstract

Combined spinal-epidural versus epidural analgesia in labour

Abstract: Analysis 2.5. Comparison 2 Combined spinal-epidural versus low-dose epidural, Outcome 5 Number of women who mobilise....

Cited by 202 publications

References 73 publications

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

Hemodynamic Impact of Intrathecal versus Epidural Analgesia with Sufentanil in the Early Phase of Labor: A Randomized Controlled Trial

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Effects of Epidural Analgesia on Labor, Delivery and Neonatal Outcomes in Patients Performed Epidural Analgesia During Labor

Contact Info

Product

Resources

About