Document Detail

Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women.
MedLine Citation:
PMID:  9392696     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Among nulliparous women, there appears to be an association between the use of epidural analgesia during labor and an increased risk of dystocia. We tested the hypothesis that combined spinal-epidural analgesia, which permits ambulation during labor, is associated with a lower incidence of dystocia than continuous lumbar epidural analgesia. METHODS: Between July 1995 and September 1996, we randomly assigned 761 nulliparous women in spontaneous labor at term who requested epidural analgesia to receive either continuous lumbar epidural analgesia or a combination of spinal and epidural analgesia. Among the women who received combined spinal-epidural analgesia, some were discouraged from walking and others were encouraged to walk. Maternal and neonatal outcomes, the incidence of dystocia necessitating cesarean section, and measures of patients' satisfaction were compared in the two groups. RESULTS: There were no significant differences in the overall rate of cesarean section, the incidence of dystocia, the frequency of maternal or fetal complications, the patients' or nursing staff's assessment of the adequacy of analgesia, or the degree of overall satisfaction between the two groups. Significantly more women receiving combined spinal-epidural analgesia had pruritus (P<0.001) and requested additional epidural bolus doses of local anesthetic (P=0.01). For all the women, dystocia necessitating cesarean section was significantly more likely when analgesia was administered with the fetal vertex at a negative station (odds ratio, 2.5; P<0.001) or at less than 4 cm of cervical dilatation (odds ratio, 2.2; P<0.001). CONCLUSIONS: As compared with continuous lumbar epidural analgesia, the combination of spinal and epidural analgesia is not associated with an overall decrease in the incidence of cesarean delivery.
M P Nageotte; D Larson; P J Rumney; M Sidhu; K Hollenbach
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  337     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1997-12-11     Completed Date:  1997-12-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1715-9     Citation Subset:  AIM; IM    
Women's Hospital, Long Beach, CA, USA.
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MeSH Terms
Analgesia, Epidural* / adverse effects
Analgesia, Obstetrical* / adverse effects
Analgesics, Opioid
Anesthesia, Spinal* / adverse effects
Anesthetics, Local
Cesarean Section
Dystocia / etiology,  prevention & control,  surgery
Labor, Obstetric* / drug effects
Prospective Studies
Risk Factors
Time Factors
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 437-38-7/Fentanyl
Comment In:
N Engl J Med. 1997 Dec 11;337(24):1764-6   [PMID:  9392705 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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