title: A randomized trial of intrapartum analgesia in women with severe preeclampsia.
abstract: OBJECTIVE
  To estimate whether the cesarean delivery rate differs between women with severe preeclampsia who receive intrapartum epidural analgesia versus patient-controlled intravenous opioid analgesia.
  
  
  METHODS
  Women with severe preeclampsia at at least 24 weeks' gestation were randomly assigned to receive either intrapartum epidural (n = 56) versus patient-controlled intravenous opioid analgesia (n = 60), and each was administered by a standardized protocol. The sample size was selected to have 80% power to detect at least a 50% difference in the predicted intergroup cesarean delivery rates. Data were analyzed by intent to treat.
  
  
  RESULTS
  Selected maternal characteristics and neonatal outcomes were similar in the two groups. The cesarean delivery rates in the epidural group (18%) and the patient-controlled analgesia group (12%) were similar (P =.35). Women who received epidural analgesia were more likely to require ephedrine for the treatment of hypotension (9% versus 0%, P =.02), but their infants were less likely to require naloxone at delivery (9% versus 54%, P <.001). Epidural analgesia provided significantly better pain relief as determined by a visual analogue intrapartum pain score (P <.001) and a postpartum pain management survey (P =.002).
  
  
  CONCLUSIONS
  Compared with patient-controlled intravenous opioid analgesia, intrapartum epidural analgesia did not significantly increase the cesarean delivery rate in women with severe preeclampsia at our level III center, and it provided superior pain relief.
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35249-7333, USA.
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Head
authors.forename: John
authors.initials: J
authors.lastname: Owen
authors.forename: Robert D
authors.initials: RD
authors.lastname: Vincent
authors.forename: Grace
authors.initials: G
authors.lastname: Shih
authors.forename: David H
authors.initials: DH
authors.lastname: Chestnut
authors.forename: John C
authors.initials: JC
authors.lastname: Hauth
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005283:Fentanyl; D006801:Humans; D008614:Meperidine; D007744:Obstetric Labor Complications; D010147:Pain Measurement; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008614:Meperidine; D005283:Fentanyl; D002045:Bupivacaine