Abstract
With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia.
Highlights
The chronic pain associated with pregnancy has been understood [1]
The results presented no statistically significant shortening of the duration of the second stage of labor in the intermittent epidural bolus (IEB) group
The results presented no statistically significant shortening of the duration of the second example, the lower end confidence interval (CI) for the weighted mean differences (WMDs) for the duration of the first stage of labor was −34.41, which stage of labor in the IEB group (WMD, −3.82 min; 95% CI, −8.28 to 0.64; Figure 4b)
Summary
The chronic pain associated with pregnancy has been understood [1]. It seems that during pregnancy, it is safe to use medications that are used in therapeutic doses for chronic pain. Chronic pain may accompany women until childbirth. The importance of managing chronic pain during pregnancy by obstetrical providers is well known. Obstetrical providers are faced with labor pain for parturients. In the early period, regarding complement of the second stage of labor, the process of epidural labor analgesia principally consists of a single injection of local anesthetic via an epidural needle. Compared with the total labor time, lessened pain relief duration ordinarily limits the type of analgesia. Childbirth is potentially treated as the suffering experience of a parturient [2]
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