A Comparison of the Effect of Extradural and Parenteral Analgesia on Maternal Plasma Cortisol Concentrations During Labour and the Puerperium

Abstract

Summary Maternal plasma levels of cortisol were measured serially by radioimmunoassay in two groups of 12 patients during induced labour and in the puerperium. One group was given continuous extradural analgesia throughout labour, the other group received pethidine and promazine in response to pain. Pre‐induction cortisol levels were significantly higher in patients who were to have extradural analgesia but the percentage increase in plasma cortisol during labour was considerably less than in patients with parenteral analgesia; in second stage labour, mean cortisol levels were the same in the two groups. This study suggests that patients who had chosen to have extradural analgesia may have been more anxious before labour than the other patients but continuous, extradural analgesia suppressed to some extent the percentage increase in mean cortisol levels found during labour in patients given parenteral analgesia. In the puerperium, there was no difference in mean cortisol levels in the two groups.

Effects of Epidural Analgesia on Plasma Catecholamines and Cortisol in Parturition

“…Thus the decrease in plasma cortisol levels resulting from epidural analgesia during labour (Figs. Table 3), also observed by others (5,9,10) can be attributed also to the alleviation of stress and fear, although blocking the afferent sympathetic pathways to the fourth thoracic segment may abolish cortisol response to some extent (11,12).…”

Epidural analgesia at trial of labor after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC)

“…Remarkably, women in labor that require to have epidural analgesia have significantly higher cortisol levels than of women who do not. The maternal level decreases after relief of pain, along with the level of epinephrine (40,41). This decrease in alpha-and beta-adrenergic stimulus, which sensitivity is characteristic of the uteroplacental vascular bed, rather than the systemic vasculature, may enhance uterine perfusion leading to an effective uterine contraction pattern (23,42).…”

Neuraxial analgesia effects on labour progression: facts, fallacies, uncertainties and the future

“…Indeed, women in labor who request epidural analgesia have significantly higher cortisol levels than of women who do not. These levels decrease after relief of pain 17 . Similarly, epinephrine levels decrease after initiation of epidural analgesia 18 .…”

“…These levels decrease after relief of pain. 17 Similarly, epinephrine levels decrease after initiation of epidural analgesia. 18 This decrease in aand b-adrenergic receptor stimulation may enhance uterine perfusion leading to a more effectual contraction pattern.…”