The Effect of Adding a Background Infusion to Patient-Controlled Epidural Labor Analgesia on Labor, Maternal, and Neonatal Outcomes

Heesen, M.; Böhmer, Johannes; Klöhr, S.; Hofmann, Thomas; Rossaint, Rolf; Straube, Sebastian

doi:10.1213/ane.0000000000000743

Cited by 43 publications

(34 citation statements)

References 17 publications

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“…Although these estimates are based on publications by the Cochrane Collaboration, others have also found that publications in obstetrics and gynaecology journals comprise a large portion of systematic reviews available [ 36 ]. As such, it should come as no surprise that systematic reviews and meta-analysis in Pregnancy and Childbirth have shaped essential clinical decisions, such as timing of corticosteroid administration for women at risk for preterm birth [ 32 ], methods of labour induction [ 37 ], approaches to intrapartum anaesthesia [ 38 , 39 ], interventions for postpartum complications [ 40 ] and more [ 41 – 45 ]. With increased availability and use of systematic reviews and meta-analyses in making clinical decisions, it is essential that the quality of these works be maintained at the highest level.…”

Section: Discussionmentioning

confidence: 99%

Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals

et al. 2016

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BackgroundSystematic reviews and meta-analyses that do not include unpublished data in their analyses may be prone to publication bias, which in some cases has been shown to have deleterious consequences on determining the efficacy of interventions.MethodsWe retrieved systematic reviews and meta-analyses published in the past 8 years (January 1, 2007–December 31, 2015) from the top 20 journals in the Pregnancy and Childbirth literature, as rated by Google Scholar’s h5-index. A meta-epidemiologic analysis was performed to determine the frequency with which authors searched clinical trials registries for unpublished data.ResultsA PubMed search retrieved 372 citations, 297 of which were deemed to be either a systematic review or a meta-analysis and were included for analysis. Twelve (4 %) of these searched at least one WHO-approved clinical trials registry or clinicaltrials.gov.ConclusionSystematic reviews and meta-analyses published in pregnancy and childbirth journals do not routinely report searches of clinical trials registries. Including these registries in systematic reviews may be a promising avenue to limit publication bias if registry searches locate unpublished trial data that could be used in the systematic review.

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Section: Discussionmentioning

confidence: 99%

Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals

et al. 2016

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“…The intrathecal block might cut off the afferent impulse of the muscular spindle, which may reduce the stretch reflex of the abdominals and pelvic floor muscles whose muscle force and muscular tension will be correspondingly weakened. This all results in a weakening of the total labor force, therefore prolonging the second and third stages of labor and causing more postpartum bleeding [14] (Tables 8 and 9). The research by Wood shows that once the air-blood that covers PH, PO2, and BE is dropped, PCO2 increases substantially [15] (Table 10).…”

Section: Applied In Painless Labormentioning

confidence: 99%

The clinical research into the application of multifunctional airbag abdominal pressure belt in midwifery and in the prevention of postpartum hemorrhage

Zhao

Wen

Niu

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Most North American and European institutions undertake standard labor epidural analgesic regimens including local anesthetics combined with an opioid given via CEI with or without PCEA boluses. Although compared with non-neuraxial analgesia, CEI with or without PCEA has better analgesic effects, as high doses of local anesthetic doses lead to profound motor blockade [ 5 ]. There is a decreased ability to move, decreased pelvic floor muscle tension, and inability to hold down during the second stage of labor.…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia

Tzeng

Kao

Pan

et al. 2020

IJERPH

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With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia.

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The Effect of Adding a Background Infusion to Patient-Controlled Epidural Labor Analgesia on Labor, Maternal, and Neonatal Outcomes

Abstract: On the basis of current evidence, no conclusion can be drawn regarding the risks or benefits of adding a continuous background infusion to PCEA compared with PCEA-only epidural labor analgesia. Further high-quality studies involving a sufficient number of patients are required.

Cited by 43 publications

References 17 publications

Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals

Clinical trials registries are underused in the pregnancy and childbirth literature: a systematic review of the top 20 journals

The clinical research into the application of multifunctional airbag abdominal pressure belt in midwifery and in the prevention of postpartum hemorrhage

A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia

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