Labour analgesia and obstetric outcomes

Cambic, Christopher; Wong, Cynthia A.

doi:10.1093/bja/aeq311

Cited by 183 publications

(102 citation statements)

References 76 publications

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“…1,33 Prolongation of labour has been associated with epidural labour analgesia. 1,34,35 The prolonged second stage of labour we observed suggests that this phenomenon may be an effect of the concentration of local anesthetic.…”

Section: Discussionmentioning

confidence: 79%

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Sultan

Murphy

Halpern

et al. 2013

Can J Anesth/J Can Anesth

124

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Introduction The influence that different concentrations of labour epidural local anesthetic have on assisted vaginal delivery (AVD) and many obstetric outcomes and side effects is uncertain. The purpose of this meta-analysis was to determine whether local anesthetics utilized at low concentrations (LCs) during labour are associated with a decreased incidence of AVD when compared with high concentrations (HCs). Methods We searched PubMed, Ovid EMBASE, Ovid MEDLINE, CINAHL, Scopus, clinicaltrials.gov, and Cochrane databases for randomized controlled trials of labouring patients that compared LCs (defined as B 0.1% epidural bupivacaine or B 0.17% ropivacaine) of epidural local anesthetic with HCs for maintenance of analgesia. The primary outcome was AVD and secondary outcomes included Cesarean delivery, duration of labour, analgesia, side effects (nausea and vomiting, motor block, hypotension, pruritus, and urinary retention), and neonatal outcomes. The odds ratios (OR) or weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated using random effects modelling. An OR \ 1 or a WMD \ 0 favoured LCs. Results Eleven studies met our criteria (eight bupivacaine and three ropivacaine studies), providing 1,145 patients in the LCs group and 852 patients in the HCs group for analysis of the primary outcome. Low concentrations were associated with a reduction in the incidence of AVD (OR = 0.70; 95% CI 0.56 to 0.86; P \ 0.001). There was no difference in the incidence of Cesarean delivery (OR 1.05; 95% CI 0.82 to 1.33; P = 0.7). The LCs group had less motor block (OR 3.9; 95% CI 1.59 to 9.55; P = 0.003), greater ambulation (OR 2.8; 95% CI 1.1 to 7.14; P = 0.03), less urinary retention (OR 0.42; 95% CI 0.23 to 0.73; P = 0.002), and a shorter second stage of labour (WMD -14.03; 95% CI -27.52 to -0.55; P = 0.04) compared with the HCs group. There were no differences between groups in pain scores, maternal nausea and vomiting, hypotension, fetal heart rate abnormalities, five-minute Apgar scores, and need for neonatal resuscitation. One-minute Apgar scores \ 7 favoured the HCs group (OR 1.53; 95% CI 1.07 to 2.21; P = 0.02), and there was more pruritus in the LCs group (OR 3.36; 95% CI 1.00 to 11.31; P = 0.05). Conclusion When compared with HCs of local anesthetics, the use of LCs for labour epidural analgesia reduces the incidence of AVD. This may be due to a Author contributions Pervez Sultan, Caitriona Murphy, Stephen Halpern, and Brendan Carvalho made substantial contributions to the conception and design of the study and were involved in drafting the article for important intellectual content. -013-9981-z reduction in the amount of local anesthetic used and the subsequent decrease in motor blockade. We therefore recommend the use of LCs of local anesthetics for epidural analgesia to optimize obstetric outcome.123 Can J Anesth/J Can Anesth (2013) 60:840-854 DOI 10.1007/s12630 RésuméObjectif Nous connaissons mal l'influence de différentes concentrations d'anesthésique local pour la péridurale...

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Section: Discussionmentioning

confidence: 79%

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Sultan

Murphy

Halpern

et al. 2013

Can J Anesth/J Can Anesth

124

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“…Pharmacological methods include parenteral opioids, inhalational agents, and epidural analgesia [4][5][6][7]. Epidural analgesia is seen as the gold standard for labor pain relief in the modern obstetric practice [8].…”

Section: Introductionmentioning

confidence: 99%

Awareness and Perception of Epidural Labor Analgesia Amongst Parturient in South Eastern Nigeria

Onyekwulu¹

2017

CMR

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This study was carried out to assess the awareness, perceptions, acceptance, and the level of utilization of epidural analgesia in relation to other methods of labor pain relief among prospective parturient attending the ante-natal clinic in south eastern Nigeria. Women attending the ante-natal clinic were interviewed using interviewer administered questionnaires containing both open and closed questions, to evaluate their awareness, perceptions, acceptance and level of utilization of labor analgesia in general and epidural analgesia in particular. Data were analysed using SPSS Statistics Version 21.0. The study included 150 women with mean age of 29.63±5.02. Most of the respondents (94.7%) had at least secondary school education. More than half the respondents (62.7%) knew about labor analgesia and 38.7% knew about epidural labor analgesia. Source of knowledge to vast majority (75.6%) were doctors and nurses. Majority of the multiparous respondents (81.27%) had moderate or severe pain in the previous confinement and only 53% had pain relieve. Of those who had pain relieve, two third hard breathing exercises while 4.8% had epidural analgesia. Majority of the respondents (72.7%) would want to have labor analgesia, and 53.3% desired epidural in their next delivery. There is poor level of awareness and utilization of epidural labor analgesia by women attending an antenatal clinic in south eastern Nigeria.

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“…Neuroaxial analgesic technique are gold standards for pain relief during labour and delivery. 1 The intrathecal opioids have been used to increase the duration of postoperative analgesia without affecting the sympathetic and motor functions. 2 Opioids with µ-receptor agonists like fentanyl, buprenorphine, etc.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of intrathecal bupivacaine alone, bupivacaine with butorphanol and bupivacaine with dexmedetomidine for lower segment caesarean section: a randomized control trial

Meitei

Rubina

Laithangbam

et al. 2016

Int J Basic Clin Pharmacol

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INTRODUCTIONThe need for early ambulation for caring of the neonate by mother makes postoperative pain management after caesarean delivery unique. To achieve this, various drug combinations and techniques have been tried to find out the more effective and safer analgesia. Most breast feeding women may choose to limit their systemic analgesic doses. Neuroaxial analgesic technique are gold standards for pain relief during labour and delivery.1 The intrathecal opioids have been used to increase the duration of postoperative analgesia without affecting the sympathetic and motor functions. Opioids with µ-receptor agonists like fentanyl, buprenorphine, etc. have been tried extensively for this purpose. However, side effects due to µ-receptor stimulation like respiratory depression, pruritus, urinary retention and abuse liability remain a concern.To alleviate this problem alpha agonist like clonidine have been used alone or in combination with opioids for lower abdominal surgery and labour analgesia.3-6 Despite increasing the duration of postoperative analgesia, alpha2 agonist also causes side effects like sedation, dryness of mouth and hypotension specially in higher dose. Dexmedetomidine is another highly selective alpha2 agonist which has been used in surgical patients ABSTRACT Background: Following caesarean operation, a painless early ambulation is necessary to mother for caring of the neonate. Aim of the study is to compare more effective analgesic by intrathecal bupivacaine or combination with butorphanol or dexmedetomidine. Methods: Ninety parturients undergoing elective caesarean section were randomly divided into three equal groups (n=30). Group B: received bupivacaine (0.5%) 2 ml + 0.5 ml of normal saline (NS); group BB, bupivacaine (0.5%) 2 ml + 25 mcg butorphanol in 0.5 ml NS and group BD, bupivacaine (0.5%) 2ml + 2.5 mcg of dexmedetomidine in 0.5 ml NS . Visual numerical rating scale (VNRS), heart rate, blood pressure, sensory and motor block levels, fetal outcome by Apgar score and umbilical cord blood pH, any side effects were noted. Results: The onset time of modified Bromage 3 motor block was statistically significant among the groups (P=0.023) but not significant between Groups BB and BD (P=0.479). The regression time to reach modified Bromage 0 in group BD was significantly longer (P=<0.0001) than either of the groups B or BB but not significant between the later two groups (P=0.479). Time for 2-segment regression, sensory regression time to S1 dermatome and time for first rescue analgesia were significantly longer (P<0.001) in group BD but not significant between the groups B and BB. Sedation was significantly more in group BD (17/30 pts; P<0.001). Conclusions: Addition of dexmedetomidine to spinal bupivacaine block in caesarean section increase the duration of analgesia and motor block with minimal side effect and no adverse effects on the babies.

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Labour analgesia and obstetric outcomes

Cited by 183 publications

References 76 publications

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Awareness and Perception of Epidural Labor Analgesia Amongst Parturient in South Eastern Nigeria

Evaluation of intrathecal bupivacaine alone, bupivacaine with butorphanol and bupivacaine with dexmedetomidine for lower segment caesarean section: a randomized control trial

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