title: [Efficacy and delivery outcomes of women underwent double-catheter epidural block during labor].
abstract: OBJECTIVE
  To investigate the efficacy and pregnancy outcomes of women receiving double-catheter epidural block in labor analgesia, and compare the results with single-catheter epidural block.
  
  
  METHODS
  A double-blind clinical trial was conducted on 206 full-term singleton primiparas, aged 25 - 35 and at the 37 - 42 weeks of gestation who delivered at the Department of Obstetrics, Qingdao Municipal Hospital from August 2006 to December 2008, which were randomly divided into two groups: double-catheter epidural block (group D, n = 103) and single-catheter epidural-block (group S, n = 103). Women in group D were given mixture of 0.1% repivacaine hydrochloride and 0.5 mg/L sufentinil 4 - 6 ml as initial dose. Patient control epidural analgesia pump (PCEA) was connected with the upper catheter after 45 minutes. A bolus dose of 4 - 6 ml analgesia mixture was infused according to the condition through the lower catheter. Women in group S received analgesia mixture 10 - 15 ml as initial dose and PCEA pump was connected after 45 minutes. Oxytocin was infused in both groups according to uterine contraction after 30 minutes. The following indexes was observed: (1) visual analogue scales (VAS); (2)modified Bromage Scores; (3) the total dose of analgesia mixture, the percentage of oxytocin infusion, duration of labor and duration of the second stage of labor; (4) fetal birth weight and Apgar scores (1, 5 minutes); (5) mode of delivery; (6) the concentration of plasma cortisol and angiotension II at the beginning of regular uterine contraction and at the time when cervical dilated to 4 cm and 10 cm and fetal disengagement; (7) anesthesia-related complications.
  
  
  RESULTS
  (1) The neonatal birth weight and Apgar scores (1, 5 minutes) of group D were (3456 ± 468) g, 9.8 ± 0.6 and 9.9 ± 0.7, respectively, while (3399 ± 569) g, 9.8 ± 0.5 and 9.9 ± 0.7 in group S (P > 0.05). No motor function block was reported in any group and the modified Bromage score was zero. (2) The total dose of analgesia mixture in group D was similar to that in group S [(57 ± 9) ml vs. (58 ± 11) ml, P > 0.05]. However, the percentage of women received oxytocin in group D was smaller [59.2% (61/103) vs. 81.6% (84/103), P < 0.01], and the total time of labor and the duration of second stage of labor in group D were shorter [(532 ± 140) minutes vs. (608 ± 150) minutes; (46 ± 31) minutes vs. (60 ± 34) minutes, P < 0.05]. (3) There were no significant differences in VAS at 30 minutes after initial dose and in the first stage of labor between group D and S (1.2 ± 1.1 vs 1.2 ± 1.1, 1.1 ± 1.1 vs. 1.2 ± 1.0, P > 0.05). VAS at the second stage of labor stage was lower in group D than in group S (1.2 ± 1.1 vs. 4.5 ± 2.2, P < 0.01). (4) The rate of cesarean section, instrumental delivery and episiotomy in group D were lower than in group S (7.8% vs. 17.5%, 7.8% vs. 15.5%, 10.7% vs. 18.4%, P < 0.05). The incidence of fetal distress and meconium-stained amniotic fluid as the indication of cesarean section were similar between the two groups (P > 0.05). Lower incidence of fetal malpresentation and arrested second stage of labor were shown in group D than in group S (2.9% vs. 9.7%, 1.0% vs. 5.8%, P < 0.05). (5) The concentration of plasma cortisol and angiotension II were lower in group D than in group S [(86 ± 25) ng/L vs. (100 ± 20) ng/L, (278 ± 53) nmol/L vs. (311 ± 53) nmol/L, P < 0.05] only at the end of second stage of labor, but not at any other times (P > 0.05). (6) No serious anesthesia-related complications were reported in any groups. Some light backache around the puncture point were complained by 29.1% (30/103) of the women in group D and 31.1% (32/103) in group S (P > 0.05).
  
  
  CONCLUSIONS
  Double-catheter epidural block can provide better analgesia effect during labor than single-catheter epidural block, without any adverse influence on delivery outcomes.
authors.affiliation: Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao 266071, China.
authors.forename: Jing-zhu
authors.initials: JZ
authors.lastname: Li
authors.forename: Ming-shan
authors.initials: MS
authors.lastname: Wang
authors.forename: Xiang-hong
authors.initials: XH
authors.lastname: Ji
authors.forename: Li-li
authors.initials: LL
authors.lastname: Zheng
authors.forename: Hong
authors.initials: H
authors.lastname: Tao
authors.forename: Yan-lin
authors.initials: YL
authors.lastname: Bi
authors.forename: Fei
authors.initials: F
authors.lastname: Shi
authors.forename: Yu-qiu
authors.initials: YQ
authors.lastname: Liu
authors.forename: Yu-qiu
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Lin-ping
authors.initials: LP
authors.lastname: Kang
authors.forename: Fu-guo
authors.initials: FG
authors.lastname: Ma
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use; D016362:Analgesia, Obstetrical / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods*; D001034:Apgar Score; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000187:drug effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000577:Amides; D010121:Oxytocin; D017409:Sufentanil