Intrathecal narcotics are associated with prolonged second-stage labor andincreased oxytocin use

BACKGROUND Safe and effective labor analgesia is an important part of obste tric care. Intrathecally injected narcotics (ITN) are an effective alternat ive to epidural anesthesia, and are perceived less likely to interfere with the course and outcome of labor. Data on their effects, however, are spars e and contradictory. METHODS Our retrospective study compared labor length, oxytocin use, delive ry type. maternal side effects, and neonatal outcomes among women who recei ved ITN (n=100) and a group who received intravenous narcotics or no analge sia during labor(n=100). We randomly sampled medical records with stratific ation for parity and collected data through systematic chart review. RESULTS Women receiving ITN were more likely to be white. They experienced longer second-stage labors (73 minutes vs 40 minutes, P=.000) and used oxyt ocin twice as often. These differences remained significant after controlli ng for potential confounding factors. ITN use was also associated with a tr end toward more cesarean sections (7% vs 1%, P=.06). More of the women rece iving ITN required urinary catheterization (25% vs 5%, P=.000) and experien ced significant pruritus (10% vs 0%, P=.001). Neonatal outcomes were simila r for both groups. CONCLUSIONS In our retrospective study, ITN use was associated with a signi ficant prolongation of second-stage labor, which may be clinically relevant for women having their first child. ITN were also associated with increase d oxytocin use and a trend toward more cesarean births. Whether these relat ionships are causal or a proxy for more difficult labors is a question for future prospective studies.