Reply from the authors

Abstract

our NHS trust over the last few years, and in particular how to prevent it.We conducted an audit in 2005 of 129 patients (56 epidurals) and confirmed the findings in many of the studies referenced that epidurals are associated with an increase in maternal temperature. As a result, more patients with a temperature over 388C were investigated for potential infective causes (especially chorioamnionitis). There was an increase in the number of mothers having antibiotics and babies being admitted to Special Care Baby Unit (SCBU) among those whose temperature increased above 388C.We hypothesized that paracetamol given at the time of epidural insertion, and then 6 hourly, could reduce the incidence of a maternal temperature increase. In 2009, we conducted a further audit involving 155 patients (63 epidurals) ( Table 1).Our 2005 data show that there is a statistically significant association between the use of epidurals in labour and both a modest increase in temperature of 0.58C (P.0.001) and the clinically important increase in temperature to 388C (P.0.005). In 2009, with the prophylactic use of paracetamol, this association is no longer present (P.0.07 and .0.18, respectively). A comparison of the epidural data between 2005 and 2009 shows a significant decrease in the likelihood of developing a significant increase in temperature with the use of prophylactic paracetamol (P.005). The odds ratio indicates that you are 3.2 times more likely to develop a temperature with an epidural in labour if you do not give paracetamol prophylactically. In both audits, although there were more cultures taken in the epidural group, there was no increase in the number of positive cultures. There certainly seems to be some benefit to the use of paracetamol prophylactically for patients with epidurals. We are in the process of a two-centre study, comparing patients with and without paracetamol on a larger scale to assess whether there is a true benefit. 1 de Orange FA, Passini R, Amorim M, Almeida T, Barros A. Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.Editor-We thank Drs Akerman and Hall for their interesting comments on our study 1 and for sharing the results of their audit. The first report of an increase in maternal temperature after anaesthesia was published in 1989 as the result of a study that compared epidural anaesthesia with meperidine. 2 That study revealed a significant increase in mean temperature in the epidural group 6 h after delivery. Similar results were later reported by other investigators. The cause of this increase in maternal temperature after epidural anaesthesia remains to be clarified. Most investigators believe that it may be the result of maternal thermoregulatory changes during childbirth. However, others consider this increase to be a consequence of subclinical placental infections, since maternal fever is more common in women undergoing prolonged labour or prolonged rupture of membranes. With respect to combined spinal-ep...