The effects of different epidural analgesia formulas on labor and mode of delivery in nulliparous women.
OBJECTIVE
Patient-controlled epidural analgesia (PCEA) and continuous epidural infusion (CEI) are popular and effective methods for pain relief during labor; however, there are concerns about increasing rates of cesarean section (C/S) and instrumental delivery. This prospective study investigated the effect of PCEA and CEI with different formulas on labor and the mode of delivery in nulliparous women.


METHODS
A total of 480 nulliparous women were randomized into four groups, with 120 in each. Group A received a loading dose of 10 mL of 1 mg/mL ropivacaine with 2 μg/mL fentanyl, then an intermittent bolus of 5 mL with a background infusion of 5 mL/hour by PCEA. Group B received the same PCEA formula as Group A with 0.8 mg/mL bupivacaine. Group C received the same formula as Group A by CEI with 1 mg/mL ropivacaine at a rate of 10 mL/hour. Group D received the same formula as Group C with 0.8 mg/mL bupivacaine. The rates of C/S and instrumental delivery and the incidence of side effects were recorded.


RESULTS
The rates of C/S were significantly different between Groups A and C, Groups A and D, and Groups B and D. The rates of instrumental delivery for normal spontaneous delivery were significantly different between Groups A and B, A and D, B and C, and C and D.


CONCLUSIONS
The C/S rate was higher in Groups C and D; however, the instrumental delivery rate was lower in Groups A and C. We conclude that PCEA with 1 mg/mL ropivacaine might provide the greatest benefit for labor analgesia.
Department of Anesthesiology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
Shin-Yan
SY
Chen
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Pei-Lin
PL
Lin
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Yu-Hsuan
YH
Yang
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Ya-Min
YM
Yang
Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Chien-Nan
CN
Lee
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Shou-Zen
SZ
Fan
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan; Department of Anesthesiology, Washington University School of Medicine in Saint Louis, MO, USA; Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan. Electronic address: clk0619kimo@msn.com.
Li-Kuei
LK
Chen
D000328:Adult; D000577:Amides / Q000627:therapeutic use*; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl
analgesia; analgesic techniques (epidural); anesthetics local (bupivacaine); anesthetics local (ropivacaine); patient-controlled analgesic techniques