Epidural versus non-epidural analgesia for pain relief in labour

Howell, Charlotte

doi:10.1002/14651858.cd000331

Cited by 153 publications

(144 citation statements)

References 25 publications

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“…79,80 L La ab bo ou ur r e ep pi id du ur ra al ls s a an nd d o ou ut tc co om me e An erudite and interesting historical review of anesthesia for childbirth by Caton, Frölich, and Euliano provides the foundation for a discussion of the con-troversies and unresolved issues surrounding the influence of epidural analgesia on maternal outcomes that affect the fetus and newborn. 81 There have been five systematic reviews 54,[82][83][84][85] comparing epidural to non-epidural analgesia methods. All focused in some manner on the clinical dilemma of balancing the alleviation of maternal pain with the possible increase in side effects and/or adverse outcomes for the mother and baby.…”

Section: Neuraxial Lamentioning

confidence: 67%

“…91 Epidural analgesia has been associated with a higher rate of operative vaginal deliveries. [82][83][84][85] Recently, the COMET study group 92 showed that there was a decreased incidence of instrumental vaginal delivery when lower doses of medication (CSE, low dose LA plus opioid infusion) were used in labour compared to conventional doses of LA (0.25% bupivacaine). The presumed mechanism is the preservation of motor tone and the bearing-down reflex.…”

Section: Instrumental Vaginal Deliverymentioning

confidence: 99%

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Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

118

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P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

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Section: Neuraxial Lamentioning

confidence: 67%

Section: Instrumental Vaginal Deliverymentioning

confidence: 99%

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

118

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“…[3][4][5] There was no difference in mode of delivery between epidural and non-epidural groups. Nafisi S et al found that there was no statistical difference in rates of vacuumassisted delivery rate and caesarean deliveries, differences in the duration of the active-first and the second stages of labor.…”

Section: Discussionmentioning

confidence: 99%

“…Following every top up dose 10 minute monitoring for uterine contractions and effect for adequate analgesia was noted. Side effects and complaints noted at 5, 15, 30, 45, 60, 90, 120, 150 and 180 min interval. Fetal condition was also monitored and evidence of fetal distress, on clinical and/or cardiotocographic monitoring, was recorded.…”

mentioning

confidence: 99%

To study the role of epidural analgesia in anaemic parturients

Chaudhary

Singh

Pandey

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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Background: To study the safety of epidural analgesia, effect on cardiotocographic parameters, fetal outcome and obstetric outcome of epidural analgesia in anaemic parturients and maternal satisfaction as well as pain relief among antenatal cases admitted in Upper India Sugar Exchange, GSVM Medical College, Kanpur, UP, India. Methods: This prospective study was conducted in anaemic parturients with cephalic presentation, singleton pregnancy having 36-42 weeks of gestation. Subjects of present study were divided into 2 groups. Control group included anaemic parturients not undergoing epidural analgesia. Study group included anaemic parturients who will be undergoing epidural analgesia. All these patients were followed up to delivery. When cervix was 3cm dilated, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Top up dose (0.0625% bupivacaine) was injected through catheter on parturients demand. For effect on CTG parameters, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Following every top up dose 10 minute monitoring for uterine contractions and effect for adequate analgesia was noted. Side effects and complaints noted at 5, 15, 30, 45, 60, 90, 120, 150 and 180 min interval. Fetal condition was also monitored and evidence of fetal distress, on clinical and/or cardiotocographic monitoring, was recorded. Patients walking duration was recorded in relation to study time from epidural insertion to delivery time. Labour was managed and mode of delivery and time of delivery was noted. Assessment of neonatal outcome was done with the help of Apgar scoring at 1 and 5minute after delivery and NICU admissions. Results: Maximum numbers of patients are lying between age groups of 18-23 and 24-29 years and are of gestational age group 37-40 weeks in both study and control group. The duration of 1st stage of labour in maximum number of primigravida patients is 5-8 hours and in multigravida it was 2-4 hours in both epidural and control group. The visual analogue scale is according to pain perceived during the course of labour and delivery by the epidural and control group. The degree of pain relief is statistically highly significant between epidural and control groups. Occurrences of maternal tachycardia are 5 times more in cases in whom epidural analgesia was not given. Conclusions: There is no statistically significant difference in the duration of 2nd stage of labour in both the groups of primigravida as well as there is no effect on the duration of second stage of labour in multigravida parturients in both the groups. Pain relief was more in the epidural group and was more satisfied after their delivery. There was no difference in effect on fetal outcome in epidural and control groups. There was no significant effect on cardiotocographic parameters except for the fact that for about 30 minutes post epidural top-up, there was fetal bradycardia which easily subsided with conservative management with left lateral position and oxygen. Maternal tachycardia...

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“…ETA-ANALYSES of clinical trials comparing epidural analgesia with parenteral opioid analgesia have suggested that epidural analgesia, while providing superior pain relief, may prolong first and second stage of labour. 1,2 However, another quantitative review of clinical studies of the possible effect of epidural analgesia on outcome of labour concluded that it was unclear whether epidural administration of local anesthetics had any effect on duration of labour. 3 A recent randomized clinical trial of parturients with epidural analgesia vs women receiving pain relief with im meperidine during labour also failed to detect a difference between groups in duration of first or second stage of labour.…”

mentioning

confidence: 99%