Sh. Halpern et al., Effect of epidural vs parenteral opioid analgesia on the progress of labor- A meta-analysis, J AM MED A, 280(24), 1998, pp. 2105-2110
Citations number
46
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Context.-Epidural labor analgesia, if selected by the patient, is associate
d with high cesarean delivery rates. Results of randomized trials comparing
rates of cesarean delivery using epidural anesthesia vs parenteral opioids
are inconsistent.
Objective.-To review the effects of epidural vs parenteral opioid analgesia
on cesarean delivery rates.
Data Sources.-Studies were identified by searching MEDLINE from January 196
6 through January 1998, the Cochrane Database of Perinatal Trials, and rele
vant nonindexed journals and abstracts.
Study Selection.-We included all studies that randomized patients to epidur
al vs parenteral opioid labor analgesia.
Data Extraction.-Two authors independently extracted data from 10 trials en
rolling 2369 patients. Odds ratios (ORs) for categorical data, weighted mea
n differences (WMDs) for continuous data, and 95% confidence intervals (CIs
) were calculated using a random-effects model.
Data Synthesis.-The risk of cesarean delivery did not differ between patien
ts receiving epidural (8.2%) vs parenteral opioid (5.6%) analgesia (OR, 1.5
; 95% CI, 0.81-2.76). Epidural patients had longer first (WMD, 42 minutes;
95% CI, 17-68 minutes) and second (WMD, 14 minutes; 95% CI, 5-23 minutes) l
abor stages. While epidural patients were more likely to have instrumented
delivery (OR, 2.19; 95% CI, 1.32-7.78), they were no more likely to have in
strumented delivery for dystocia (OR, 0.68; 95% CI, 0.31-1.49). After epidu
ral analgesia, neonates were less likely to have low 5-minute Apgar scores
(OR, 0.38; 95% CI, 0.18-0.81) or to need naloxone (OR, 0.24; 95% CI, 0.07-0
.77). Women receiving epidural analgesia had lower pain scores during the f
irst (WMD, -40 mm on a 100-mm scale; 95% CI, -42 to -38 mm) and second (WMD
, -29 mm; 95% CI, -38 to -21 mm) stages of labor. The odds of dissatisfacti
on were lower with epidural analgesia (OR, 0.25; 95% CI, 0.20-0.32).
Conclusions.-Epidural labor analgesia is not associated with increased rate
s of instrumented vaginal delivery for dystocia or cesarean delivery. Patie
nts receiving epidural analgesia have longer labors. Patient satisfaction a
nd neonatal outcome are better after epidural than parenteral opioid analge
sia.