Epidural Analgesia Compared with Combined Spinal-Epidural Analgesia During Labor in Nulliparous Women
| Autor: | Mohan Sidhu, David Larson, Michael P. Nageotte, Katherine Hollenbach, Pamela J. Rumney |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
medicine.medical_specialty Time Factors Walking Anesthesia Spinal Fentanyl law.invention Randomized controlled trial Pregnancy Risk Factors law Humans Medicine Prospective Studies Anesthetics Local Prospective cohort study reproductive and urinary physiology Bupivacaine Labor Obstetric Cesarean Section Obstetrics business.industry Incidence (epidemiology) Spontaneous labor General Medicine Continuous lumbar epidural analgesia medicine.disease Dystocia Analgesia Epidural Analgesics Opioid Lower incidence Parity Increased risk Combined spinal epidural Neonatal outcomes Anesthesia Analgesia Obstetrical Gestation Female Complication business medicine.drug |
| Zdroj: | Survey of Anesthesiology. 43:82 |
| ISSN: | 0039-6206 |
| DOI: | 10.1097/00132586-199904000-00023 |
| Popis: | Among nulliparous women, there appears to be an association between the use of epidural analgesia during labor and an increased risk of dystocia. We tested the hypothesis that combined spinal-epidural analgesia, which permits ambulation during labor, is associated with a lower incidence of dystocia than continuous lumbar epidural analgesia.Between July 1995 and September 1996, we randomly assigned 761 nulliparous women in spontaneous labor at term who requested epidural analgesia to receive either continuous lumbar epidural analgesia or a combination of spinal and epidural analgesia. Among the women who received combined spinal-epidural analgesia, some were discouraged from walking and others were encouraged to walk. Maternal and neonatal outcomes, the incidence of dystocia necessitating cesarean section, and measures of patients' satisfaction were compared in the two groups.There were no significant differences in the overall rate of cesarean section, the incidence of dystocia, the frequency of maternal or fetal complications, the patients' or nursing staff's assessment of the adequacy of analgesia, or the degree of overall satisfaction between the two groups. Significantly more women receiving combined spinal-epidural analgesia had pruritus (P0.001) and requested additional epidural bolus doses of local anesthetic (P=0.01). For all the women, dystocia necessitating cesarean section was significantly more likely when analgesia was administered with the fetal vertex at a negative station (odds ratio, 2.5; P0.001) or at less than 4 cm of cervical dilatation (odds ratio, 2.2; P0.001).As compared with continuous lumbar epidural analgesia, the combination of spinal and epidural analgesia is not associated with an overall decrease in the incidence of cesarean delivery. |
| Databáze: | OpenAIRE |
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