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A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate
Affiliations- Department of Obstetric and Gynaecological Nursing, Medical University in Gdansk, Poland, Poland
open access
Abstract
Objectives: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function.
Material and methods: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients.
Results: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery.
Conclusions: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient’s higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects.
Abstract
Objectives: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function.
Material and methods: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients.
Results: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery.
Conclusions: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient’s higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects.
Keywords
epidural analgesia, labour, delivery, caesarean section, instrumental delivery
About this articleTitle
A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate
Journal
Issue
Article type
Review paper
Pages
460-467
Published online
2018-08-31
Page views
2582
Article views/downloads
1802
DOI
Pubmed
Bibliographic record
Ginekol Pol 2018;89(8):460-467.
Keywords
epidural analgesia
labour
delivery
caesarean section
instrumental delivery
Authors
Wioletta Mędrzycka-Dabrowska
Katarzyna Czyż-Szypenbejl
Jakub Pietrzak
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