Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

Abstract

Background To investigate the relationship between intrapartum maternal fever and the duration and dosage of patient-controlled epidural analgesia (PCEA). Methods This observational study included 159 pregnant women who voluntarily accepted PCEA. During labor, patients with body temperature ≥ 38 °C were classified into the Fever group, (n = 42), and those with body temperature < 38 °C were classified into the No-fever group (n = 117). The outcome measures included the duration of PCEA, number of PCEA, and total PCEA amount. Body temperature and parturient variables, including interpartum fever status and the duration of any fever were monitored. Results The total PCEA duration and total PCEA amount in the Fever group were significantly higher than the corresponding values in the No-fever group (both, p < 0.05). The duration of fever was weakly correlated with the duration of PCEA (R2 = 0.08) and the total PCEA amount (R2 = 0.05) (both, p < 0.05). The total and effective PCEA were higher in the Fever group than in the No-fever group (both, p < 0.05). The total PCEA duration and total PCEA amount were positively correlated with the incidence of fever (both, p < 0.05). The diagnostic cutoff value for fever was 383 min, with a sensitivity of 78.6% and specificity of 57.3%. The mean temperature-time curves showed that parturients who developed fever had a steeper rise in temperature. Conclusions This study showed that there were weak time- and dose-dependent correlations between PCEA and maternal fever during delivery. A total PCEA duration exceeding 6.3 h was associated with an increase in the duration of maternal intrapartum fever.

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study

“…This implies a lack of correlation between ERMF and neonatal hypoxia. Other studies conducted by our group ( 13 ) have also yielded similar results.…”

Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis

“…The finding that reducing the dose of local anaesthetic administered by epidural analgesia may reduce the incidence of intrapartum fever is supported by the results of observational studies reporting time- and dose-dependent correlations between epidural analgesia and intrapartum fever development. 88 Further studies have also supported the association between duration of epidural analgesia and development of intrapartum fever. Lieberman and colleagues 89 observed that amongst women who received an epidural the incidence of fever increased from 7% for labours <6 h to 36% for labours >18 h, and Yin and Hu 90 observed that labouring <6 h with epidural analgesia did not increase the risk of fever development, but that risk did increase significantly when epidural analgesia lasted >6 h. This evidence supports the concept that total local anaesthetic dose plays an important role in the mechanism of intrapartum fever development, as the longer an epidural is in situ , the higher the dose received.…”

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors

“…Labour analgesia can effectively relieve pain and improve the success rate of vaginal delivery. However, during childbirth, women may have fever, and the probability of fever in women who choose labour analgesia is significantly higher (Viscomi & Manullang, 2000; Zhao et al, 2021). This study found that the incidence of maternal intrapartum fever in women undergoing epidural analgesia was 27.55%.…”