title: The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women.
abstract: A randomized, double blind, placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.125% bupivacaine beyond a cervical dilatation of 8 cm in nulliparous women. When the cervix was greater than or equal to 8 cm dilated, coded study solution was substituted for the known 0.125% bupivacaine solution. The study solution for 46 patients was 0.125% bupivacaine; 46 patients received saline. During the first stage of labor, 44 (96%) women in the bupivacaine group, and 45 (98%) in the saline group, had analgesia of excellent or good quality. During the second stage, 36 (82%) women in the bupivacaine group, versus 18 (41%) women in the saline group, had analgesia of excellent or good quality (P less than .0001). Six (13%) women in each group underwent cesarean delivery after the start of the study solution. Among the women who delivered vaginally, the mean (+/- S.D.) duration of the second stage of labor was 124 (+/- 70) min in the bupivacaine group, versus 94 (+/- 54) min in the saline group (P less than .05). Twenty-one of 40 (53%) women in the bupivacaine group, versus 11 of 40 (28%) in the saline group, underwent instrumental vaginal delivery (P less than .05). Twenty-eight of 40 (70%) women in the bupivacaine group, versus six of 40 (15%) in the saline group; had surgical perineal anesthesia for vaginal delivery (P less than .0001). There were no significant differences between groups in Apgar scores or umbilical cord blood acid-base values.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.forename: D H
authors.initials: DH
authors.lastname: Chestnut
authors.forename: G E
authors.initials: GE
authors.lastname: Vandewalker
authors.forename: C L
authors.initials: CL
authors.lastname: Owen
authors.forename: J N
authors.initials: JN
authors.lastname: Bates
authors.forename: W W
authors.initials: WW
authors.lastname: Choi
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D002045:Bupivacaine; D002986:Clinical Trials as Topic; D036861:Delivery, Obstetric / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000187:drug effects*; D007743:Labor, Obstetric / Q000187:drug effects*; D010298:Parity; D011247:Pregnancy; D011897:Random Allocation
chemical_list: D002045:Bupivacaine