title: The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial.
abstract: BACKGROUND
  This prospective, randomized study was performed to see if intermittent labor epidural analgesia was protective against maternal intrapartum fever, compared to continuous epidural infusion.
  
  
  METHODS
  Ninety-two healthy, term, nulliparous women in spontaneous labor were assigned to either intermittent (ILEA) or continuous labor epidural analgesia (CLEA), 46 in each group. In both groups, epidural analgesia was established with fentanyl 100 microg, and 8 mL of either 0.125% bupivacaine with fentanyl 0.0002%, or 0.1% ropivacaine with fentanyl 0.0002%. Maintenance in the CLEA group was with the same bupivacaine/fentanyl or ropivacaine/fentanyl solutions at 10-15 mL/h. In the ILEA group, additional boluses of the same solution were given as needed. Maternal tympanic temperature was measured before epidural insertion, 4-hourly during labor and 4 h post partum. Fever was defined as a temperature of > or =38 degrees C. Newborn temperature was noted within 60 min of birth.
  
  
  RESULTS
  The incidence of fever in ILEA was significantly lower at four hours (2/42, vs. 10/44 in CLEA, P=0.036). No significant differences were detected at other time periods. Mean maternal temperatures did not differ between groups at any time. There were no differences in neonatal temperature or neonatal sepsis evaluation rate (CLEA vs. ILEA 0/46 vs. 2/43, P=0.45).
  
  
  CONCLUSIONS
  Intermittent epidural injections appear to protect against intrapartum fever in the first 4 hours of labor analgesia, compared to continuous infusion. This may be due to intermittent partial recovery of heat loss mechanisms between injections. Neonatal sepsis evaluation rates were similar in the two groups.
authors.affiliation: Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. manthav@anes.upmc.edu
authors.forename: V R R
authors.initials: VR
authors.lastname: Mantha
authors.forename: M C
authors.initials: MC
authors.lastname: Vallejo
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
authors.forename: A L
authors.initials: AL
authors.lastname: Phelps
authors.forename: S
authors.initials: S
authors.lastname: Ramanathan
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D001831:Body Temperature / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology; D013997:Time Factors