Effect of labor analgesia on labor outcome.
OBJECTIVE
Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration.


RESULTS
Compared with parenteral opioids, neuraxial analgesia does not increase the incidence of cesarean section, although it is associated with a longer (approximately 16 min) second stage of labor. The incidence of operative vaginal delivery is higher in the epidural group but this may be due to indirect reasons such as changes in physician behavior. There was no difference in labor outcome when CSE was compared with low-concentration epidural analgesia, but higher concentrations may prolong labor. Early administration of neuraxial analgesia does not increase the incidence of operative delivery or prolong labor.


CONCLUSIONS
Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.
University of Toronto and Sunnybrook Health Sciences Centre, Division of Obstetrical Anesthesia, Toronto, Canada. Stephen.Halpern@sunnybrook.ca
Stephen H
SH
Halpern
Faraj W
FW
Abdallah
D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000775:Anesthesia, Spinal / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007747:Labor Stage, First / Q000187:drug effects; D007743:Labor, Obstetric / Q000187:drug effects*; D011247:Pregnancy
D000701:Analgesics, Opioid