Epidural analgesia during labor vs no analgesia: A comparative study

Abstract

Background:Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia.Methods:One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded.Results:There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group.Conclusion:Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

O uso de analgesia farmacológica influencia no desfecho de parto?

“…In addition, it is imperative that all women be informed of the risks and benefits of using pharmacological analgesia, including their recurrent use, so that they become more secure and are protagonists of their birth process and the decisions involved in it. (5,19) It should be noted that some practices that may possibly influence the incidence of instrumental vaginal delivery were not analyzed and consists in limitations of this study . These include maternal position during labor, information about which was absent in more than onethird of the charts, and analgesia dosages, which were not documented in the medical records.…”

“…(3,19) A possible biological explanation for the association found is the effect of epidural analgesia on motor function, relaxing the pelvic floor musculature and causing motor blockade, which leads to a decrease in effective maternal pushing and involuntary reflex. (5,19) This motor depression has been questioned as a minimum, depending on the concentration of medication used. (19,20) Another explanation may be that most pregnant women are primiparous, whose labor is usually longer.…”

“…Still, the use of pharmacological analgesia should follow clinical protocols based on upto-date scientific evidence, especially with regard to dosages, since it has been shown that less concentrated doses do not cause motor blockade, allowing the parturient to continue to participate actively in the labor process. (3,7,19) Instrumental vaginal delivery can be considered a rare event (8.4%) in the institution studied, indicating that humanized practices contribute to better delivery outcomes, even though the use of analgesia may increase the chance of delivery with instrumentation. In addition, it is imperative that all women be informed of the risks and benefits of using pharmacological analgesia, including their recurrent use, so that they become more secure and are protagonists of their birth process and the decisions involved in it.…”

“…(5,19) This motor depression has been questioned as a minimum, depending on the concentration of medication used. (19,20) Another explanation may be that most pregnant women are primiparous, whose labor is usually longer. (21) This finding points to the need to expand studies to better evaluate this association, as well as to inform women about this possibility when using pharmacological analgesia.…”

Labour with low dose epidural analgesia: maternal perception and fetal outcome

“…[7][8][9] There was no difference in mean duration of first stage of labour in both groups with p value of 0.54 which is statistically insignificant, our results were similar to study by Wesam F M et al 8 Second stage of labour was slightly prolonged in EA group than NA group with mean of 71.63 minutes and 23 respectively which gives significant p value of <0.001 which is similar to study by Agrawal D et al 7 Present study results of no difference in first stage and prolonged second stage are similar to several previous studies. [10][11][12] Present study showed no difference in APGAR scores in both groups similar to studies by Agrawal R et al and Mousa et al 7,8 …”