RANDOMIZED TRIAL OF EPIDURAL VERSUS INTRAVENOUS ANALGESIA DURING LABOR

Objective: To compare the effects of epidural analgesia with intraveno us (IV) analgesia on the outcome of labor. Methods: Thirteen hundred t hirty women with uncomplicated term pregnancies and in spontaneous lab or were randomized to be offered epidural bupivacaine-fentanyl or IV m eperidine analgesia during labor. Results: Comparison of the allocatio n groups by intent to treat revealed a significant association between epidural allocation and operative delivery for dystocia. However, onl y 65% of each randomization group accepted the allocated treatment. Fo ur hundred thirty-seven women accepted and received meperidine as allo cated, and they were compared with 432 women accepting epidural alloca tion. Significant associations resulted between epidural administratio n and prolongation of labor, increased rate of oxytocin administration , chorioamnionitis, low forceps, and cesarean delivery. Because of the high rate of noncompliance with treatment allocation, a multifactoria l regression analysis was performed on the entire cohort, and a twofol d relative risk of cesarean delivery persisted in association with epi dural treatment. The impact of epidural treatment on cesarean delivery was significant for both nulliparous and parous women (risk ratios 2. 55 and 3.81, respectively). Epidural analgesia provided significantly better pain relief in labor than did parenteral meperidine. Conclusion : Although labor epidural analgesia is superior to meperidine for pain relief, labor is prolonged, uterine infection is increased, and the n umber of operative deliveries are increased. A two- to fourfold increa sed risk of cesarean delivery is associated with epidural treatment in both nulliparous and parous women.