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Impact of Three Neuraxial Analgesia Techniques on Labor Duration in Nulliparous Parturients
Abstract Number: BP-04
Abstract Type: Original Research
Although never assessed as a primary outcome, the impact of neuraxial labor analgesia on the duration of the first stage of labor has been assessed as a secondary outcome in several studies, with conflicting results.1-3 We performed a randomized control trial investigating the impact of type of neuraxial labor analgesia on the duration of the first stage of labor.
Methods: Term, healthy, nulliparous patients with cervical dilation less than 4 cm were recruited. At first request for neuraxial analgesia, patients were randomized to one of three groups: 1. epidural de novo technique with fentanyl 100μg and 0.125% bupivacaine 15-20mL; 2. CSE technique with intrathecal fentanyl 25μg; or 3. CSE technique with intrathecal 0.5% bupivacaine 2.5mg and fentanyl 15μg. Epidural analgesia was maintained with PCEA technique of bupivacaine 0.0625% and fentanyl 1.95μg /mL. Breakthrough pain was managed with manual epidural boluses of bupivacaine 1.25mg/mL, 10-15mL. Primary outcome was duration of first stage of labor, defined as the time period from first dose of neuraxial local anesthetic to complete cervical dilation. Cervical exams were performed by an OB provider immediately prior to neuraxial analgesia, and then q2 h once patient was 80-100% effaced until complete dilation. Secondary outcomes included demographic data, mode of delivery, duration of second stage of labor, overall duration of labor, VPRS at 15, 30, and 60 minutes after first analgesic dose, VPRS at each cervical exam, number of manual redoses, total amount of bupivacaine and fentanyl, nausea/vomiting, and pruritus. Data from subjects who underwent cesarean delivery were censored.
Results: 239 patients (spontaneous = 121, induction = 119) were recruited and included for analysis. Figure 1 shows no difference between the three groups for the primary outcome. Group 1 had higher pain scores at 15 and 30 minutes after first analgesic dose (p<0.001) and lower rates of pruritus (p<0.001) compared to groups 2 and 3. There was no difference between the three groups for all other secondary outcomes.
Discussion: The type of neuraxial analgesia may have no effect on the duration of first stage, second stage, or overall length of labor. As expected, CSE technique was associated with lower pain scores immediately after placement, but with a higher incidence of pruritus compared to epidural technique.
1. Anesthesiology 1999;91:920-5
2. N Engl J Med 2005;352:655-65
3. Cochrane Database Syst Rev 2011:CD000331