Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Wang, T.T.; Sun, Shujun; Huang, S.Q.

doi:10.1097/01.aoa.0000527011.77477.1c

Cited by 15 publications

(21 citation statements)

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“…Historically, epidurals consisted of concentrated local anesthetics (0.25%-0.5% bupivacaine) to achieve pain relief during labor, however these high concentrations were associated with an unacceptably high incidence of motor block in analgesia [50]. In another meta-analysis, no differences in assisted vaginal, cesarean delivery or duration of labor were found with dilute labor epidural analgesia compared to nonepidural analgesic options [52]. Similarly, a recent large randomized study found similar duration of the second stage of labor and spontaneous vaginal delivery rates when comparing 0.08% ropivacaine with 0.4 mg/ml sufentanil to placebo administered with the onset of the second stage of labor [53].…”

Section: Optimal Epidural Solutionmentioning

confidence: 99%

Modern techniques to optimize neuraxial labor analgesia

Nanji

Carvalho

2018

Anesth Pain Med

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Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patientcontrolled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.

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Section: Optimal Epidural Solutionmentioning

confidence: 99%

Modern techniques to optimize neuraxial labor analgesia

Nanji

Carvalho

2018

Anesth Pain Med

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“…When low concentration EA was compared with nonepidural analgesia, Wang et al could not demonstrate any difference in instrumental delivery rates or prolonged second stage of labour in a 2017 published metaanalysis. 26 Importantly, the authors stated that also low-quality studies were included, with an overall decline in quality and certainty of the conclusions drawn. If EA was directly related to the tremendously higher rate of instrumental delivery in our study population, it may be due to divergence of practice from universally accepted guidelines in modern obstetric anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…These findings differ from recent literature, describing an acceptable prolongation of the second stage of labour 23,36 or even no effect with low concentrations. 26 Still, the data of the National Registry gives no information on distinct stages and the timepoint of EA, hindering meaningful comparisons. The low EA rates let assume, that the choice of epidural use is more likely due to underlying circumstances of labour progress than the women's choice, making it more likely that EA was used in already prolonged labour cases.…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia during Routine Childbirth: A 10 Years Retrospective Analysis from the National Birth Registry Austria

Kraft

Wohlrab

Meyer

et al. 2020

Preprint

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Objectives To investigate the use and association of epidural analgesia (EA) on neonatal short-term outcome in vaginal childbirth at term of primiparous parturients. Design Retrospective cohort study. Setting Data of the National Birth Registry of Austria between 2008 and 2017. Population Primiparous women with spontaneous vaginal birth at term of singleton pregnancies in Austria. Methods Linear and logistic regression models to investigate an association of epidural analgesia on short-term neonatal outcome in propensity score adjusted cohorts. Main outcome measures: Short-term morbidity assessed by arterial cord pH and base excess. Secondary outcomes were admission to a neonatal intensive care unit, APGAR scores, and perinatal mortality. Results: Of 247 536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89 ± 3.2 mmol/l vs. 6.15 ± 3.2 mmol/l; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at 5 minutes below 7 was more frequent with EA (OR 1.45; 95% CI 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI 0.79 to 2.25). Conclusions EA showed no relevant association with short-term morbidity. Higher rates of NICU admission and APGAR score after 5 minutes below 7 were observed with EA. Overall use of EA in Austria is low, and investigation of causes may be indicated.

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“…Epidural analgesia can form the dissociative block because low concentration of local anesthetics and opioids in the epidural space can effectively block some sympathetic and sensory nerves without affecting the motor nerves. This treatment can induce an analgesic effect with the retention of motor function, which is particularly applicable to labor analgesia [2].…”

Section: Introductionmentioning

confidence: 99%

Factors for predicting cesarean section during epidural analgesia: a retrospective study

Wang¹,

Zhao²,

Zhou³

et al. 2019

Clin. Exp. Obstet. Gynecol.

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To explore the risk factors for cesarean section during trial of labor with epidural analgesia. Materials and methods: A total of 100 parturients who received epidural analgesia were selected for this study. Fifty parturients underwent vaginal deliveries and 50 parturients underwent cesarean sections. Patient-controlled epidural analgesia (PCEA) was carried out with the continuous infusion of 0.125% bupivacaine and 2 mcg/ml fentanyl at 6 ml/h with patient-controlled analgesia (6 ml/time, locked time 15 minutes). Results: The univariate analysis showed a significant difference in the gestational age of parturients between cesarean section and vaginal delivery (p = 0.013). Compared with the parturients in the vaginal delivery group, cesarean section group parturients showed longer interval time from epidural analgesia to cesarean section (p < 0.001), a higher number of analgesia interventions (p < 0.001), higher doses of PCEA (p < 0.001), and higher number of top-ups (p = 0.015). Multivariate analysis revealed that a high gestational age and long interval time were strongly associated with a high possibility of cesarean section during epidural analgesia. Conclusion: High gestational age and long interval time are important risk factors for the prediction of cesarean section during epidural analgesia.

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Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 15 publications

References 0 publications

Modern techniques to optimize neuraxial labor analgesia

Modern techniques to optimize neuraxial labor analgesia

Epidural Analgesia during Routine Childbirth: A 10 Years Retrospective Analysis from the National Birth Registry Austria

Factors for predicting cesarean section during epidural analgesia: a retrospective study

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