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Maternal Temperature in Labor with Lower Dose Local Anesthetic
Abstract Number: S-32
Abstract Type: Original Research
Background/Objective: Studies have shown a correlation between labor epidurals and increasing temperature during labor. For this reason, there is concern that women receiving epidurals in labor are being incorrectly diagnosed and treated for chorioamnionitis and their babies are overtreated for sepsis. The purpose of this study was to determine the temperature change in our patients who received a lower dosage of epidural anesthesia (.125% bupivacaine bolus and a continuous infusion of .0625% bupivacaine with 2 μg/ml of fentanyl) during labor than those used in the studies reporting increased temperatures after epidural (.25% bupivacaine bolus and .125% bupivacaine and 2 μg /ml fentanyl infusion).
Study Design: This was a retrospective cohort study of all deliveries during April 2011. Patients were excluded if they did not receive epidural analgesia, were not in labor or did not have a temperature taken within 1 hour of epidural placement. All temperatures recorded within the first 12 hours after epidural placement were included.
Results: A total of 196 patients met inclusion criteria. Table 1 shows mean temperatures at time of epidural placement, 3-4 hours after, 5-6 hours after, 7-9 hours after and 10-12 hours after.The mean temperature at time of epidural placement was 36.6⁰ C (range 35.2⁰ to 38.0⁰ C). After three to four hours the mean temperature was 36.8 ⁰C. By 10 to 12 hours after epidural placement the mean temperature was 36.9⁰ C (range 36⁰ to 39.2⁰ C). There was no statistical difference in temperature from baseline at any time point. A total of 9(4.6%) patients had a temperature >38.0⁰ C. Of those nine patients, four had placental pathology results available, three of which had evidence of acute chorioamnionitis.
Conclusions: In our study there was no significant rise in temperatures after epidural placement among patients receiving low-dose epidurals. If our findings are confirmed, an added benefit of lower epidural doses of local anesthetic may be that they do not lead to increased temperature in labor. When a diagnosis of chorioamnionitis is suspected in a laboring patient with an epidural, the concentration of local anesthetic given through the epidural should be considered.
1. Segal S. Labor Epidural Analgesia and Maternal Fever. Anesthesia Analgesia, 2010; 111(6):1467-1474.
2. Philip J, Alexander JM, Sharma SK et al. Epidural analgesia during labor and maternal fever. Anesthesiology, 1999 May; 90(5):1271