///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

The EASE study: A randomized controlled comparison of epidural analgesia (EA) and spinal epidural (SE) analgesia: efficacy during first and second stages of labor and at delivery.

Abstract Number: 127
Abstract Type: Original Research

David R Gambling MB,BS; FRCPC1 ; Thomas R Farrell MD2; Alex Pue MD3; Dennis Shay MD4; Jonathan Berkowitz PhD5

It has been shown that labor analgesia following spinal-epidural induction is superior to epidural alone, although others have found little difference.1,2 The aim of this prospective study was to determine the quality of analgesia during first and second stages of labor and at delivery, controlling for parity, labor induction and epidural maintenance.

Methods: Upon request for labor analgesia and with written consent, healthy women were randomly assigned to receive epidural analgesia (EA) or spinal-epidural (SE). Exclusion criteria included: inability to speak English, ASA 4, severe PIH, <37 weeks EGA, previous uterine scar, twins or BMI >40. EA received 10ml 0.125% bupivacaine with 2mcg/ml fentanyl in 2 equal doses via an epidural needle (Arrow) followed by 5 ml through the catheter. SE received 2.5ml of the same solution via a 26g spinal needle prior to epidural catheter placement. PCEA was used for the rest of labor and delivery (L&D) using the same dosing parameters. Statistical analyses included T-test, Chi -square analysis and ANOVA using SPSS.

Results: Data from 398 EA and 402 SE subjects have been analyzed. Numbers of nulliparous women and induced labors were equal in each study arm. All demographic and outcome data were similar except time to first analgesia was less with SE (10.8 vs 21.9 mins; p<0.001). SE patients had a longer 2nd stage of labor (78.2 vs 68.2 mins; p <0.05). Women who received SE had superior first stage analgesia despite a lower rate of PCEA use (ml/hr). SE required fewer epidural top-ups than EA (16.4% vs 25.6%; p<0.001) and EA patients were more likely to require more than one top-up. Second stage and delivery pain was the same. Profound fetal bradycardia (FB) within 30 mins of epidural was more with SE (8.5% vs 4.5%; p < 0.05) but the incidence of CS for FB was the same in both groups. Ephedrine use was similar. VAS itch scores were higher with SE (2.25 vs 1.69; p < 0.005) but the need for itch treatment was the same.

Conclusion: This randomized study of EA vs SE on the quality of pain relief throughout L&D showed that SE is superior for first stage analgesia but no differences could be found in second stage and delivery pain. Since epidural catheters were replaced in 1.2% (SE) - 2% (EA) of patients (p=ns), concerns about epidurals failing with CSE because of an inability to provide a test dose are unfounded.

References:

1. Goodman SR et al. Anesth Analg 2009; 108: 246-51.

2. Miro M et al. Int J Obstet Anesth 2008; 17:



SOAP 2010