Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged.
OBJECTIVE
To determine the effect of epidural analgesia on biochemical markers of stress, plasma oxytocin concentrations and frequency of uterine contractions during the first stage of labour.


METHODS
Nine nulliparous women, in spontaneous labour, with a singleton fetus and cervical dilatation < or = 5 cm were enrolled. Epidural bupivacaine 0.25% (range 10-14 ml) was administered and bilateral sensory blockade to ice (T8-L4) achieved. Blood samples were collected before the epidermal block and every 10 min for one hour after the block was achieved for the measurement of plasma beta-endorphin, cortical, glucose, lactate and oxytocin concentrations. No exogenous oxytocin was given. Intensity of pain was assessed at the time of the blood sampling using a 10 cm visual analogue scale (VAS). The frequency of uterine contractions was recorded for 60 min before and after the epidural block.


RESULTS
There was a decrease in plasma beta-endorphin and cortisol concentrations after epidural block (P < 0.01). There were no changes in plasma glucose and lactate concentrations. The mean VAS for pain decreased 10 min after epidural block was achieved and remained < 2 throughout the study period (P < 0.001). Mean plasma oxytocin concentrations did not change. The frequency of uterine contractions before and after the epidural block was similar.


CONCLUSIONS
The metabolic stress response to the pain of labour was attenuated by epidural analgesia. In contrast, plasma oxytocin concentration and frequency of uterine contractions were unaffected by the attenuation of metabolic stress response.
Department of Anesthesia, McGill University, Montréal, Québec, Canada.
T J
TJ
Scull
G T
GT
Hemmings
F
F
Carli
S K
SK
Weeks
L
L
Mazza
H H
HH
Zingg
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007743:Labor, Obstetric / Q000502:physiology*; D010121:Oxytocin / Q000097:blood; D010147:Pain Measurement; D011247:Pregnancy; D013312:Stress, Physiological / Q000503:physiopathology*; D014590:Uterine Contraction / Q000187:drug effects* / Q000502:physiology; D001615:beta-Endorphin / Q000097:blood
D010121:Oxytocin; D001615:beta-Endorphin; D006854:Hydrocortisone