Epidural analgesia with sufentanil during labor and operative delivery

Background. It has been argued that by adding an opioid to the local anesth etic drug used for epidural analgesia during childbirth, one can reduce the risk of operative delivery. Objective. In a population-based observational study, to evaluate the effec t of adding an opioid to a local anesthetic drug on the risk of instrumenta l delivery or cesarean section. Design. Comparison of delivery units adding/not adding opioid to the local anesthetic for epidural analgesia in labor. Setting. All deliveries using epidural analgesia in Sweden during 1992-96 w ere evaluated on the basis of information stored at the Medical Birth Regis try, the National Board of Health and Welfare, Stockholm. Method. A questionnaire was sent to all delivery units (n=61), as well as t o the Head of corresponding Anesthesiology Department in each hospital, req uesting information regarding the period when opioids (sufentanil) were fir st added to the local epidural analgesic. Parturients given epidural analge sia were divided into three time-related groups: those delivered before the introduction of opioids (n=34,071), when opioids were first added (12=7,23 6), and since the introduction of opioids (n=44,384). Odds ratio (OR) with 95% confidence interval (CI) was used to assess the effect of sufentanil Ve rsus no sufentanil, on the risk of operative delivery. The parturients were stratified for year of delivery, age, and parity. Main outcome measures. Instrumental delivery, cesarean section, length of s tay in hospital post partum. Results. A significant reduction was observed in the incidence of instrumen tal delivery (OR 0.72; 95% CI 0.68-0.76). A similar though less pronounced effect was evident concerning the risk of cesarean section for nulliparae ( OR 0.79; 95% CI 0.72-0.88) but not for multiparae (OR 0.93; 95% CI 0.80-1.0 7). Fewer women with an opioid added to the local anesthetic spent more tha n 4 (or more than 7) days in hospital post partum, compared with those give n epidural analgesia without an opioid. Conclusion. When added to the local anesthetic used for epidural analgesia, as in Sweden during the last 5 years, opioids appear to reduce the inciden ce of instrumental delivery and cesarean section and also the post partum h ospital stay.