Does epidural increase the incidence of cesarean delivery or instrumental labor in Saudi populations?
BACKGROUND
This is a retrospective review of the medical records of 861 patients admitted for vaginal delivery. Patients were randomized to either epidural analgesia or other analgesic methods of pain relief for labor pains. The primary purpose of this study was to evaluate the effect of epidural analgesia on the rate of cesarean section delivery.


METHODS
861 patients were admitted to Saad Specialist Hospital for vaginal delivery between May 1, to September 30, 2006. Patients were divided into Nulliparous (334 patients) and Multiparous (527 patients) populations. Each population was then divided into two groups, epidural and non-epidural group. Epidural analgesia was initiated by a bolus of bupivacaine 0.25% (6 to 10 ml) plus fentanyl (50 to 100 microg), followed by bupivacaine 0.125% plus fentanyl (1 to 2 microg/ml) at the rate of (6 to 12 ml/h). Non-epidural analgesia was initiated by one or mixture of I.M meperidine 50 to 100 mg I.M, promethazine hydrochloride 25 mg, or Ontonox inhalers.


RESULTS
In the Nulliparous population a total of 57 patients requested epidural (the epidural gp), while 277 patients received other analgesic methods (the non-epidural gp). There was no difference in the rate of cesarean section deliveries between the two analgesia groups (12 patients of 57 in the epidural group (21.1%), versus 61 patients of 277 (22%) in the non-epidural gp). In the Multiparous population, a total of 49 patients requested epidural analgesia (epidural gp), while 478 patients received other analgesic methods (the non-epidural gp). There was no difference in the rate of cesarean section deliveries between the two analgesia groups (5 of 49 patients (10.2%) in the epidural group compared to 39 of 478 patients (8.2%) in the non-epidural gp). Significantly, more patients in the epidural group had forceps or vacuum assisted deliveries compared to the other analgesia group (the non-epidural gp). This was evident in both the Nulliparous population (7 of 57 patients in the epidural gp (12.3%) compared to 13 of 277 patients (4.7%) in the non-epidural gp, p<0.05), and in the Multiparous population (4 of 49 patients (8.2%) in the epidural gp versus only 6 of 478 patients (1.3%) in the non-epidural gp, p<0.005). Patients in the epidural gp had significantly lower pain scores compared to the other analgesia gp. Nulliparous reported lower pain scores during the first stage (epidural 2 +/- 2 vs non-epidural 5 +/- 4, p<0.0001) and second stage of labor (epidural 3 +/- 3 vs non-epidural 6 +/- 3, p<0.0001). Multiparous scores were (epidural 2 +/- 2 vs non-epidural 4 +/- 3, p<0.0001) in the first stage and (epidural 3 +/- 3 vs non-epidural 5 +/- 4, p = 0.0007) in the second stage. Higher satisfaction rates were reported in epidural groups versus the non-epidural groups. 80% of Nulliparous women who received epidural rated their satisfaction as excellent or good versus 45% in the non-epidural group p<0.001. In the Multiparous population 77% in the epidural versus 43% in the non-epidural groups p<0.001 reported excellent to good satisfaction rates.


CONCLUSIONS
Epidural analgesia is an effective method of pain relief during labor compared to the other analgesic methods of labor pain relief, and it does not increase the incidence of cesarean section deliveries.
Anesthesia Department, SAAD Specialist Hospital, El Khobar, KSA.
Hassan
H
Bakhamees
Esmat
E
Hegazy
D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001794:Blood Pressure / Q000502:physiology; D002045:Bupivacaine; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005283:Fentanyl; D006801:Humans; D009772:Obstetrical Forceps; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D016896:Treatment Outcome; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010100:Oxygen; D005283:Fentanyl; D002045:Bupivacaine