To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Epidural During Labour Does Not Increase Cesarean Delivery Rates URL: http://www.pslgroup.com/dg/D60EE.htm Doctor's Guide December 22, 1998
CHICAGO, IL -- Dec. 22, 1998 -- The use of epidural analgesia (continuous infusion of medication into the spinal canal) for pain relief during labour does not significantly increase the rate of cesarean delivery as previously believed. It also is more effective for pain relief and has less impact on the health of newborns than narcotic injections, according to a review article in the Dec. 23/30, 1998 issue of The Journal of the American Medical Association. Stephen Halpern, M.D., of the University of Toronto in Ontario, and colleagues researched the medical literature and combined the results of 10 studies (randomised clinical trials that included a total of 2,369 patients) and found that there was no statistically significant increase in cesarean deliveries when epidural analgesia was used compared to narcotic injections. The cesarean rate for patients who received epidural pain relief was 8.2 percent (97 out of 1,183 deliveries). The cesarean rate for patients who received narcotic pain injections was 5.6 percent (67 out of 1,186 deliveries). This study combined the results from the 10 different clinical trials to create a meta-analysis, which is a systematic review that pools the results from different trials and studies in order to create a larger, more comprehensive overview. "Epidural analgesia [pain relief] effectively alleviates labour pain; however, controversy exists about the effect of epidural analgesia on labour outcome," the researchers write. "In particular, several observational studies and one randomised controlled trial have shown an increase in cesarean delivery in women who receive epidural labour analgesia compared with women who receive parenteral [by some other means than through the gastrointestinal tract-for example, intravenous] opioids[narcotics]. "These results have led some health care plans to deny reimbursement for epidural labour analgesia in an attempt to minimise costs." The first and second stages of labour were longer in patients who received epidural pain relief compared to those who received narcotic injections. However, patients who received epidural analgesia reported improved pain relief and less dissatisfaction compared to those who received narcotic injections for pain. "Epidural analgesia provided clearly superior pain relief. There is no study in which patient comfort in the opioid group equalled or surpassed the comfort of patients in the epidural group," they write. "Intermittent nurse-administered opioids provided no measurable analgesia, as assessed by before-and-after visual analog pain scores. "Patient-controlled administration of intravenous opioids provides some comfort. However, patients receiving epidural analgesia were still more comfortable than patients receiving patient-controlled analgesia with opioids." Parenteral opioids are the most frequently prescribed alternative to epidural labour analgesia, they write. However, in routinely used doses, parenteral opioids have little effect on labour pain. "Severe, unrelieved labour pain causes patient dissatisfaction and is associated with postpartum depression and posttraumatic stress disorder," they write. "The neonates [newborns] of mothers receiving epidural analgesia were more alert, had a lower incidence of mild acidosis [an accumulation of acid in the blood] and required naloxone [a drug that reverses the effects of narcotics] less frequently than the neonates of mothers receiving parenteral opioids. "The currently available evidence shows no association between epidural analgesia and the overall cesarean delivery rate or the rate of instrumented vaginal or cesarean delivery for dystocia [complications during labour]. Thus, a policy of withholding epidural analgesia will not reduce cesarean delivery rates. Parenteral opioids are associated with poor maternal pain relief and less vigorous neonates. This information should be available to women so that they can make informed choices about labour pain relief." Related Links: The Journal of the American Medical Association --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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