Epidural versus non-epidural analgesia for pain relief in labour.
BACKGROUND
Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear.


OBJECTIVE
The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour.


METHODS
The Cochrane Pregnancy and Childbirth Group trials register was searched.


METHODS
Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade, or no intervention.


METHODS
Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information.


RESULTS
Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section rates could be identified.


CONCLUSIONS
Epidural analgesia appears to be very effective in reducing pain during labour, although there appear to be some potentially adverse effects. Further research is needed to investigate adverse effects and to evaluate the different techniques used in epidural analgesia.
Howell
C J
CJ
Academic Department of Obstetrics and Gynaecology, North Staffordshire Hospital NHS Trust, Maternity Hospital, Newcastle Road, Stoke on Trent, Staffordshire, UK, ST4 6QG. cjh@kogs.demon.co.uk
D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D010146:Pain; D011247:Pregnancy; D012306:Risk