The effect of intrapartum epidural analgesia on nulliparous labor: A randomized, controlled, prospective trial

Thorp, James A.; Hu, Daniel; Albin, Rene M.; McNitt, Jay D.; Meyer, Bruce A.; Cohen, Gary R.; Yeast, John D.

doi:10.1016/0002-9378(93)90015-b

Cited by 418 publications

(163 citation statements)

References 5 publications

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“…This study has addressed two issues: firstly, is it safe for the mother to stand and walk with regional blockade and secondly, does it have a positive impact on the progress of labour by shortening the duration of labour and reducing the incidence of instrumental delivery [7,8]? There have now been studies that have shown that reducing motor block per se, long blamed for increasing instrumental delivery rates associated with regional analgesia in labour, does not improve the outcome of labour [9].…”

Section: Discussionmentioning

confidence: 99%

Effect of maternal ambulation on labour with low‐dose combined spinal–epidural analgesia

Collis¹,

Harding²,

Morgan³

1999

Anaesthesia

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SummaryTwo hundred and twenty-nine nulliparous women who requested regional analgesia during labour were given a combined spinal-epidural block. They were randomly allocated to stay in bed or spend at least 20 min of every hour out of bed. There was no significant difference in duration of labour, analgesia requirements, mode of delivery or condition of the baby between the groups. Ambulation appeared to be safe for the mother and baby. Maternal satisfaction with the low-dose combined spinal-epidural was high in both groups.

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Section: Discussionmentioning

confidence: 99%

Effect of maternal ambulation on labour with low‐dose combined spinal–epidural analgesia

Collis¹,

Harding²,

Morgan³

1999

Anaesthesia

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“…The superiority of EDA in comparison with systemic opioid analgesia is well established in a number of RCTs (table 2). There seems to be a steep fall in pain scores (0-10) from 7.1-7.9 to 0-4 during the first hour (Thorp et al 1993, Bofill et al 1997, Jain et al 2003) with a sustained effect throughout the 1 st stage of labour. Most studies compared EDA with systemic pethidine which has been thought to provide near to no analgesia at all in labour pain (Olofsson et al 1996b, Ranta et al 1994.…”

Section: Analgesia With Remifentanil Epidural Block and Nitrous Oxidementioning

confidence: 92%

“…Most studies compared EDA with systemic pethidine which has been thought to provide near to no analgesia at all in labour pain (Olofsson et al 1996b, Ranta et al 1994. A decrease of pain by 0-4 with systemic opioid analgesia from a baseline pain score of 6.9-9 on a scale of 0-10 has been noted, however, in several large studies (Thorp et al 1993, Ramin et al 1995, Sharma et al 1997, Bofill et al 1997, Jain et al 2003 (table 2). In a systematic review, Leighton & Halpern (2002) calculated a weighted mean difference of 40 mm in favour of EDA for the 1 st stage of labour (p < 0.0001).…”

Section: Analgesia With Remifentanil Epidural Block and Nitrous Oxidementioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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“…We attribute this increased rate of treatment to the increased risk of cesarean delivery and third or fourth degree laceration associated with epidural analgesia in our study population. Several randomized prospective studies have shown an increased risk of cesarean delivery with epidural analgesia, 4,18 while others have shown no increased risk with epidural analgesia 3,6 or combined spinal-epidural analgesia. 5 Less controversial is the causal role of epidural analgesia in an increased risk of a second stage longer than 2 hours 4,5 in women with epidural analgesia contributing to the higher rates of operative vaginal delivery seen in most prospective studies.…”

Section: Antibiotic Treatment For Surgical Prophylaxismentioning

confidence: 99%

“…5 Less controversial is the causal role of epidural analgesia in an increased risk of a second stage longer than 2 hours 4,5 in women with epidural analgesia contributing to the higher rates of operative vaginal delivery seen in most prospective studies. A summary statistic of the four best prospective studies [3][4][5]18 where elective forceps were not allowed yields a relative risk of 1.9 for forceps delivery in the setting of epidural analgesia (95% CI 1.4, 2.5). Excess operative vaginal deliveries have been implicated in the increased rate of third and fourth degree lacerations seen in women with epidural analgesia.…”

Section: Antibiotic Treatment For Surgical Prophylaxismentioning

confidence: 99%

Maternal Epidural Analgesia and Rates of Maternal Antibiotic Treatment in a Low-risk Nulliparous Population

et al. 2003

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BACKGROUND:Epidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined. METHODS:We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of <99.51F. Antibiotic use during labor was categorized by indication. RESULTS:A total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group. CONCLUSION:Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

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The effect of intrapartum epidural analgesia on nulliparous labor: A randomized, controlled, prospective trial

Cited by 418 publications

References 5 publications

Effect of maternal ambulation on labour with low‐dose combined spinal–epidural analgesia

Effect of maternal ambulation on labour with low‐dose combined spinal–epidural analgesia

Intravenous patient-controlled analgesia with remifentanil in early labour

Maternal Epidural Analgesia and Rates of Maternal Antibiotic Treatment in a Low-risk Nulliparous Population

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