Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

Jia, Lijie; Cao, Huimin; Guo, Yuna; Shen, Ying; Zhang, Xiaoyu; Zhou, Feng; Liu, Jiangruixuan; Xie, Zhongcong; Xu, Zifeng

doi:10.1001/jamanetworkopen.2021.23757

Cited by 15 publications

(9 citation statements)

References 53 publications

(128 reference statements)

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“…Neuraxial analgesia is considered the most effective method for reducing pain during labor and decreasing the risk of postpartum depression [ 19 , 20 ]. However, the historical estimated overall prevalence of neuraxial analgesia use in China was 10% [ 21 ], while this ratio in France and the United States was 88% and 73%, respectively [ 4 , 22 ]. Meanwhile, the rate of cesarean delivery in China was among the highest worldwide in 2007 (46%) and 2014 (35%) [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Wang

Xu²,

Zhao³

et al. 2022

BMC Anesthesiol

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Background Humane treatment requires the provision of appropriate sedation and analgesia during medical diagnosis and treatment. However, limited information is available about the status of procedural analgesic interventions in Chinese hospitals. Therefore, a nationwide survey was established to identify challenges and propose potential improvement strategies. Methods Forty-three members of the Pain Group of Chinese Society of Anesthesiology established and reviewed the questionnaire, which included (1) general information on the hospitals, (2) the sedation/analgesia rate in gastrointestinal endoscopy, labor, flexible bronchoscopy, hysteroscopy in China, (3) staff assignments, (4) drug use for procedural analgesic interventions, and (5) difficulties in procedural analgesic interventions. The data were obtained using an online questionnaire sent to the chief anesthesiologists of Chinese hospitals above Grade II or members of the Pain Group of Chinese Society of Anesthesiology. Results Valid and complete questionnaires were received from 2198 (44.0%) hospitals, of which 64.5% were Grade III. The overall sedation/analgesia rates were as follows: gastroscopy (50.6%), colonoscopy (53.7%), ERCP (65.9%), induced abortion (67.5%), labor (42.3%), hysteroscopy (67.0%) and fiber bronchoscopy (52.6%). Compared with Grade II hospitals, Grade III hospitals had a higher proportion of procedural analgesic interventions services except for induced abortion. On average (median [IQR]), each anesthesiologist performed 5.7 [2.3—11.4] cases per day, with 7.3 [3.2—13.6] performed in Grade III hospitals and 3.4 [1.8—6.8] performed in Grade II hospitals (z = -7.065, p < 0.001). Conclusions Chinese anesthesiologists have made great efforts to achieve procedural analgesic interventions, as evidenced by the increased rate. The uneven health care provided by hospitals at different levels and in different regions and the lack of anesthesiologists are the main barriers to optimal procedural analgesic interventions.

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Section: Discussionmentioning

confidence: 99%

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Wang

Xu²,

Zhao³

et al. 2022

BMC Anesthesiol

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“…[3][4][5] EA is constantly being promoted in China, 6 EA rate in China can be over 50%. 7,8 With the use of EA, cesarean delivery due to pain factors has been greatly reduced. 9,10 EA can also enhance the relationship between mother and child.…”

Section: Introductionmentioning

confidence: 99%

“…Many developed countries now have EA rates of 70% or more 3–5 . EA is constantly being promoted in China, 6 EA rate in China can be over 50% 7,8 . With the use of EA, cesarean delivery due to pain factors has been greatly reduced 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Effects of epidural analgesia at 1 cm cervical dilatation on labor interventions in full‐term primigravida: A retrospective cohort study

Chen

et al. 2023

J of Obstet and Gynaecol

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Objective This study aimed to investigate the effects of epidural analgesia administered as early as cervical dilatation of 1 cm on labor interventions and maternal and neonatal outcomes. Methods This retrospective research recruited 1007 full‐term primigravidas, who were distributed to two separate cohorts for eligibility: epidural analgesia 1 (cervical dilatation = 1 cm) and epidural analgesia 2 (cervical dilatation >1 cm). Labor interventions (artificial rupture of membranes and oxytocin administration) and duration of labor were the primary outcomes. Results The effect of initiation timing of epidural analgesia on artificial membrane rupture was not statistically significant (adjusted odds ratio [OR]: 0.85 [0.58–1.24], p > 0.05). Less oxytocin was used in the epidural analgesia 2 group compared with the epidural analgesia 1 group (the adjusted OR: 0.68 [0.49–0.95], p < 0.05). There were no significant differences in the median time to latent phase of labor, active phase of labor, second, and third stages of labor (p > 0.05). There were no significant differences in maternal and neonatal outcomes between the epidural analgesia 1 group and the epidural analgesia 2 group. Conclusion Epidural analgesia could be administered at cervical dilatation = 1 cm.

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“…The duration of hospital stay and the levels of inflammatory markers were far lower in pregnant women who received labor analgesia than in those who did not. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant for Combined Spinal–Epidural Analgesia for Labor

Deep¹,

Jain²,

Mittal³

et al. 2022

Anesthesia Essays &Amp; Researches

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Background: Combined spinal–epidural technique is a widely accepted and popular modality for labor analgesia. Opioids are being used as adjuvants since long time. Dexmedetomidine is a new drug that is being used as an intrathecal adjuvant. Aim: The study aims to compare the safety and efficacy of fentanyl and dexmedetomidine as intrathecal adjuvants in labor analgesia. Settings and Design: This was a continuous, prospective, randomized controlled trial with 120 parturients. Materials and Methods: After ethical approval and written consent, participants were divided randomly into two groups: Group A – bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 20 μg of dexmedetomidine in 1 mL saline intrathecally (total volume: 3 mL) and Group B – bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 15 μg of fentanyl in 1 mL saline intrathecally (total volume: 3 mL). Primary outcomes were satisfactory analgesia, mode of delivery, and neonatal outcome. Participants were monitored for the onset and duration of analgesia, degree of motor block, and maternal and fetal side effects. Results: A total of 108 parturients reported sufficient analgesia (Group A: 57; Group B: 51), and 74 patients delivered vaginally (Group A: 41; Group B: 44). The rates of normal vaginal delivery were higher in Group B. Group A reported earlier onset of analgesia (61.26 ± 18.23 s) that lasted for longer duration (124.16 ± 26.23 min) than in Group B. There were no serious side effects in any of the groups. Fetal ultrasound revealed attenuation of fetal heart rate variability. The heart rate of newborns was also found to be low in Group A. Conclusion: Chances of vaginal delivery are higher with intrathecal fentanyl as an adjuvant. Intensity and duration of analgesia are better with intrathecal dexmedetomidine.

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Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

Cited by 15 publications

References 53 publications

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Procedural analgesic interventions in China: a national survey of 2198 hospitals

Effects of epidural analgesia at 1 cm cervical dilatation on labor interventions in full‐term primigravida: A retrospective cohort study

Comparative Evaluation of Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant for Combined Spinal–Epidural Analgesia for Labor

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