Epidural Analgesia and Uterine Function

Newton, Edward R.; Schroeder, Barbara C; Knape, Kelly G.; Bennett, Bari L.

doi:10.1016/0029-7844(95)00046-t

Cited by 79 publications

(42 citation statements)

References 20 publications

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“…A caesarian rate of 12.5% in our study is comparable with that by Norris and Fogel of 13.4% (149/ 1112 patients) [11] with similar indications in the two studies. Newton and colleagues compared myometral activity in those receiving bupivacaine/fentanyl epidural infusions with non-randomised controls receiving pethidine and reported no difference, although need for oxytocin was greater and the rate of cervical dilatation slower in the epidural group [12].…”

Section: Discussionmentioning

confidence: 99%

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

K¹,

Puri²,

Goel

2006

Medical Journal Armed Forces India

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Original Article IntroductionT he control of pain should forms an integral part of the management of labour, yet pain relief in labour is a controversial subject. Pregnant woman have a right to basic information about pain and its relief in labour. Labour analgesia, is rapidly catching up in the Armed Forces, and it would still be a while, before all women in labour are offered this service. Amongst the various modalities of pain relief in labour, epidurals have gained popularity. The aim of this study was to compare a relatively less utilised opioid, butorphanol with the timetested fentanyl in epidural labour analgesia. MethodThe study was approved by our hospital ethics committee and informed consent was obtained from each patient. 64 women with American Society of Anaesthesiologists physical status I and II, between the ages of 18 and 40 years who opted for epidural labour analgesia were enrolled. Participants had singleton pregnancy of greater than 36 weeks of gestation with vertex presentation. All women were in active labour with cervical dilatation of 3 to 5 cm at the time of epidural catheter placement. The women had a pre dose Visual Analog Score (VAS) for labour pain of ≥ 30mm measured on two occasions, when two consecutive uterine contractions occurred.Patients with known hypersensitivity to local anaesthetics, neurologic, neuromuscular or psychiatric disorders, blood dyscrasias, weight greater than 110 kg, height less than 144 cm, cephalopelvic disproportion, known foetal abnormalities or multiple pregnancy were excluded from the study.Randomisation was done by the toss of a coin and patients were allocated to two groups. The first group (n=32) received 15ml of 0.1% bupivacaine with 0.1mgml -1 butorphanol (1.5mg) and the second group (n=32) received 15ml of 0.1% bupivacaine with 2μgml -1 of fentanyl. The patient and anaesthesiologist were blind to the drug combination, which was prepared by a trained assistant.All patients were started on an intravenous infusion of ringer lactate. An 18 gauge epidural catheter was placed 3 to 4 cm inside the epidural space via an 18-gauge Tuohy epidural needle at the L2-3 or L3-4 level. If there was any evidence of entry into an epidural vein or cerebrospinal fluid the patient was excluded from the study. After negative aspiration, a bolus of 15 ml of either drug was given over 5 minutes. A test dose was omitted.The efficacy of the drug was assessed using a 100 mm visual analogue scale, where 0 represented no labour pain and 100 represented the worst possible pain, at five minute intervals and during contractions for the first 20 min, at 20 minute intervals for the first hour, at 30 minute intervals for the next hour, and hourly thereafter, till the end of labour or when patient complained of pain. -1 of fentanyl. Results: The times of onset and offset of analgesia were comparable. More patients of the butorphanol group were sedated but arousable. The patient satisfaction levels were good in both groups and APGAR scores were comparable. Conclusion: Butorphanol and fe...

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Section: Discussionmentioning

confidence: 99%

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

K¹,

Puri²,

Goel

2006

Medical Journal Armed Forces India

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“…The fact that spinal anesthesia affects uterine functions is well known [11][12][13][14][15][16][17]. Nevertheless, this form of anesthesia does not prevent local origination of stimuli, nor transmission of action potentials throughout the myometrium.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, this form of anesthesia does not prevent local origination of stimuli, nor transmission of action potentials throughout the myometrium. Hence, it cannot prevent preterm labor [3,17]. Regardless of the intensity of stimulation that can potentially lead to parturition, delivery cannot occur if myometrial contraction is absent.…”

Section: Discussionmentioning

confidence: 99%

Local Anesthetics Inhibit Uterine Activity in vitro

et al. 2003

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Objective: Analysis of the effects of local anesthetics upon the gravid uterus. Methods: Isolated strips of pregnant-rat myometrium were placed within tissue baths. Muscular activity was then recorded by a force transducer, at cumulative concentrations of either procaine, lidocaine, or ropivacaine. Results: The effects of myometrial activity were non-monotonic. At lower concentrations, an increase in contraction frequency was noted, concomitant with a depression in amplitude. As the concentrations increased, both amplitude and frequency were depressed until, eventually, activity was abolished. Conclusions: Local anesthetics administered in situ consistently inhibit or completely arrest overall myometrial activity. These agents may prove clinically useful in preterm labor management, if administered locally to the myometrium via suitable slow release drug delivery systems, warranting further trials in vivo.

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“…Maternal efforts at expulsion can also be impaired, causing fetal malposition during descent. 31 Previously, the association of neonatal morbidity and mortality with longer labour (second stage longer than two hours) had justified expediting delivery, leading to increased rates of instrumental delivery. 32 Delaying maternal pushing until the fetus's head is visible or until one hour after reaching full cervical dilation may reduce the incidence of instrumental delivery and its attendant morbidity.…”

Section: Discussionmentioning

confidence: 99%

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

2004

Obstetrics & Gynecology

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Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.

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Epidural Analgesia and Uterine Function

Abstract: After epidural analgesia, myometrial contractility is maintained with oxytocin, but the ability of the uterus to dilate the cervix is reduced significantly.

Cited by 79 publications

References 20 publications

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

Local Anesthetics Inhibit Uterine Activity in vitro

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

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