Does epidural versus combined spinal-epidural analgesia prolong labor and increase the risk of instrumental and cesarean delivery in nulliparous women? - 13/08/11
: Staff Anesthesiologist, Sergi Sabaté, MD b : Staff Anesthesiologist, Pablo Otero, MD a : Staff Anesthesiologist, Jose Costa, MD a : Staff Anesthesiologist, Javier Carceller, MD a : Staff Anesthesiologist, Rocío Vázquez, MD a : Staff Anesthesiologist, María Díaz-Vieito, MD a : Staff Anesthesiologist, Alfonso Rodríguez, MD a : Staff Anesthesiologist, Julian Alvarez, MD, PhD a : Professor of AnesthesiologyAbstract |
Study Objective |
To compare duration of labor, mode of delivery, and local anesthetic consumed in women who received labor analgesia with epidural or combined spinal-epidural technique.
Design |
Retrospective, observational study.
Setting |
Delivery room of a university hospital.
Patients |
788 nulliparous women in labor at term with cervical dilation between three and 5 cm.
Interventions |
In Group E (epidural alone), parturients received an epidural solution of 8 mL (levobupivacaine 0.125% with fentanyl 5 μg/mL). In Group CSE (combined spinal-epidural), parturients received a spinal injection of levobupivacaine two mg with fentanyl 15 μg (total volume two mL). Then an epidural catheter was placed in all patients and connected to a patient-controlled analgesia pump (basal infusion rate of 8 mL/hr of 0.1% levobupivacaine and fentanyl two μg/mL, patient-controlled bolus dose of three mL, and lockout time of 30 min).
Measurements |
Labor duration, mode of delivery (spontaneous vaginal vs. instrumental delivery vs. cesarean section), and local anesthetic consumed, were recorded.
Main Results |
Labor analgesia was performed with an epidural technique in 322 patients (40.9%), and a combined spinal-epidural technique in 466 patients (59.1%), of whom 39 Group E women (12.1%) and 46 Group CSE women (9.9%) required cesarean section (P=ns). No differences in the mode of delivery were observed between the groups. Time from analgesia to delivery (Group E: 217 ± 111 min vs. Group CSE: 213 ± 115 min; P=ns), and epidural local anesthetic consumed (Group E: 35 ± 20 mL vs. Group CSE: 33 ± 20 mL; P=ns), were similar in both groups.
Conclusions |
No significant differences were observed between epidural and combined spinal-epidural given for labor analgesia in nulliparous women in duration of labor, mode of delivery, or local anesthetic consumed.
Le texte complet de cet article est disponible en PDF.Keywords : Analgesia, Obstetrical, Analgesic techniques, Combined spinal-epidural, Epidural, Subarachnoid
Plan
| ☆ | Support was provided solely from institutional and departmental sources. |
Vol 21 - N° 2
P. 94-97 - mars 2009 Retour au numéro
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