Epidural neostigmine for labor pain: a meta-analysis

Abstract

Objective To evaluate the efficacy and safety of epidural neostigmine in management of labor pain.Methods Randomized controlled trials(RCTs) about epidural neostigmine combined with local anesthetics or opioids(experimental group) versus local anesthetics or opioids alone(control group) in management of labor pain were retrieved from Cochrane Library,PubMed,EMbase,Wanfang Database,CNKI,and CBMdisc from the date of their establishment to September 2011.The methodological quality of included RCTs was evaluated by two reviewers independently,and meta-analysis was conducted with the included RCTs using RevMan 5.1.4 software.Continuous variables were dealt with mean difference and 95% confidence interval(CI),and the dichotomous variables were dealt with odd ratio and 95% CI.Results We identified 4 RCTs including 282 patients.The results of meta-analyses showed that the values of visual analogue scale(VAS) were significantly lower in the experimental group compared with the control group[low dose(1-2 μg/kg or 250 μg): MD=-1.45,95%CI(-2.84,-0.07),P=0.04;median dose(4 μg/kg or 500 μg): MD=-2.35,95%CI(-3.69,-1.02),P=0.000 6;high dose(6-7 μg/kg or 750 μg): MD=-21,95%CI(-36.31,-5.69),P=0.007].The adverse reactions such as nausea and vomiting were not significantly different between the two groups.Moreover,epidural neostigmine seemed to have no influence on the total duration of labor or the mode of delivery(cesarean section rate or instrumental delivery rate).Apgar scores of the neonates were similar in the two groups.Conclusion The results of our analysis show that epidural neostigmine combined with local anesthetics or opioids has a stronger analgesic effect in managing labor pain whithout increasing the incidence of adverse events.