Epidural Labor Analgesia Research Articles

Factors affecting womens' attitude towards labor epidural analgesia in a culturally diverse population: a prospective patient-reported outcome study.

To evaluate pregnant women's intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel. A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression. The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (P=0.024), childbirth preparation course (P=0.002), internet as source of information (P=0.016), and previous delivery with LEA (P<0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (P=0.033), partner presence (P<0.001), labor induction (P=0.044), and previous delivery with LEA (P<0.001). Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.

Investigating disparity in labor epidural analgesia management in black vs. white women: a retrospective case-control study (2018-2022).

Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race. In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible. Patients with a scheduled cesarean delivery, previous back instrumentation, or maternal age<18 were excluded. We used a Cox Proportional Hazards model to evaluate our primary outcome. Predefined top-up medications given≥60minutes from initial LEA placement and before replacement were valid. Any replacement≥60minutes from the initial LEA was valid. We also studied secondary outcomes incidence of epidural replacement and postoperative patient satisfaction. There were 11,168 total patients receiving LEA, with 479 (5.5%) replacements in White patients and 127 (5.0%) in Black patients. There were 387 (3.5%) LEAs with a top-up followed by replacement within 24hours. After adjusting for confounders, no association was detected between race and LEA management (Hazard Ratio 0.82; 95% CI 0.63, 1.06; P=0.13). We failed to detect an association between patient race and the incidence of replacement (P=0.23). We found that race (P=0.02) and LEA replacement (P<0.001) were associated with increased odds of lower postpartum satisfaction. We didn't detect disparity in treatment at our institution with standardized LEA management protocols. However, Black women and those with LEA replacements were less satisfied. Future studies should evaluate the generalizability and explore interventions that improve patient satisfaction.

Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study.

This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy. This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume>150mL, determined by catheterization after spontaneous voiding. Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was>50mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133±447mL; all were nulliparous, seven had induced labor, and five had an episiotomy. Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4hours for women who are unable to urinate spontaneously, void less than 50ml, or experience complete motor blockade during labor.

Prenatal labor analgesia education program on outcomes for primiparas: study protocol for a randomized controlled trial

BackgroundA significant number of primiparous women lack awareness of labor epidural analgesia, resulting in lower acceptance of labor epidural analgesia. Additional prenatal education may help primiparas understand labor epidural analgesia and increase labor epidural analgesia rates. This randomized controlled trial (RCT) will evaluate the effects of an online and offline prenatal labor epidural analgesia education program for primiparas to improve their labor epidural analgesia rate and to reduce their misunderstanding of labor epidural analgesia and fear of birth.MethodsA single-blinded, randomized, controlled, parallel-design trial will be conducted. Based on the Theory of Planned Behavior, online and offline prenatal labor epidural analgesia education program has five modules: (a)elementary knowledge, (b)attitude, (c)subjective norm, (d) perceived behavioral control and (e)behavioral intention. Primiparous women will be recruited in the obstetrics department or midwife clinic of a tertiary hospital in Shenzhen, China. The participants (N = 196) will be randomly allocated to the intervention group (N = 98) that receives routine prenatal education and access to the online and offline prenatal labor epidural analgesia education program and the control group (N = 98) that receives routine prenatal education. Labor epidural analgesia rate will be extracted from the electronic medical record; misunderstanding and intention of labor epidural analgesia and fear of birth will be measured at baseline and immediately after the intervention. The study was ethically approved in November 2023.DiscussionIf the online and offline prenatal labor epidural analgesia education program has positive outcomes, it may offer an effective intervention program to decrease misperceptions of labor epidural analgesia and fear of birth and to improve the labor epidural analgesia rate for Chinese primiparas. As the first RCT study to evaluate the effect of the online and offline prenatal labor epidural analgesia education program with a strict research design and a theoretical framework, this research will provide evidence on prenatal labor analgesia health education for clinical practice in China.Trial RegistrationRegistered at the Chinese Clinical Trials.gov on January 11th, 2024. Trial Registration Number: ChiCTR2400079767.

Association of epidural labor analgesia with maternal and neonatal outcomes in women with preeclampsia: a propensity score-matched single-center retrospective cohort study

BackgroundEpidural labor analgesia (ELA) is widely and safely used for labor pain relief. However, it remains unclear whether ELA affects maternal and neonatal outcomes in women suffering from preeclampsia.MethodsThis study reviewed the medical records of women with preeclampsia at ≥ 28 weeks of gestation between January 2015 and December 2020. The medical records of women were divided into ELA and no analgesia (NA) groups. The primary endpoint was the cesarean section (CS) rate. Secondary endpoints included hypotension, operative vaginal delivery, fetal distress, neonatal intensive care unit admission, and complications. Using multivariate logistic regression analysis and propensity score matching (PSM), the association between ELA and maternal and neonatal outcomes was examined.ResultsA total of medical records of 686 women were enrolled, with 242 (35.3%) receiving ELA. Of these, 126 (18.4%) had a higher incidence of CS in the ELA group than in the NA group (22.7% vs. 16.0%, P = 0.020). Multivariable analysis indicated greater risks of CS [adjusted Odds Ratio (aOR) = 1.71; 95% CI, 1.07–2.74; P = 0.025] and operative vaginal delivery (aOR = 2.810; 95% CI, 1.379–5.725; P = 0.004) in the ELA group than that of NA group. In the PSM, ELA did not increase the risk of CS (aOR = 1.56; 95% CI, 0.97–2.52; P = 0.067) and OVD (aOR = 2.048; 95% CI, 0.936–4.484; P = 0.073). The secondary endpoints showed no significant differences between the two groups.ConclusionThe study indicates an association between ELA and maternal and neonatal outcomes, supporting the safety of ELA in this population.

Maternal and Fetal Outcome in Liver Transplant Parturients

Background: Liver transplant recipients are at greater risk of both maternal and fetal complications than healthy parturients. Methods: In this retrospective study, we looked at the case files of liver transplant recipients who came for safe confinement from 2011 to 2021. Patients’ demography, transplant details, immunosuppressive regimen, pregnancy information, maternal complication, graft function, and fetal outcomes were examined. Results: A total of 12 liver recipients were delivered in this institute during this time interval. All patients had live-related liver transplants; the mean transplantation delivery interval was 4.8 years. They were all on immunosuppressant medications. Of the patients, 75% had elective cesarean delivery, which was performed under subarachnoid block. In addition, 66.7% (two-thirds) of patients who delivered vaginally had epidural analgesia. There were no severe intraoperative or postoperative maternal anesthetic complications. None of the patients had graft rejection or significant deterioration in liver function tests. Three babies (25%) were delivered preterm. One of the fetuses was stillborn. All others had an Apgar score of 9 at 5 min and did not require any intensive care unit stay. Conclusion: Pregnancy in liver transplant recipients should undergo safe confinement in a tertiary care center under the care of a multidisciplinary team including a hepatologist, transplant surgeon, obstetrician, neonatologist, and obstetric anesthesiologist. Despite the apprehension, planned pregnancies in these parturients have a good obstetric and neonatal outcome. These patients can safely undergo a lower segment cesarean section under regional anesthesia or receive labor epidural analgesia for a vaginal delivery with minimal risk of complications.

Success rate of epidural labor analgesia service at a tertiary care hospital in Nepal : An observational study

Success rate of epidural labor analgesia service at a tertiary care hospital in Nepal : An observational study

Evaluation of Epidural Analgesia for Vaginal Delivery: A Retrospective Analysis of a State Hospital

Aim: Epidural analgesia is the most commonly preferred analgesia method for labour pain management. Our purpose is to examine the effects of epidural analgesia on the mother, fetus, and the labour process in this study. Material and Methods: The files of pregnant women undergoing epidural analgesia for labour between January and December 2017 were examined retrospectively. Demographic data, hemodynamic parameters, duration of labour stages, rates of conversion to caesarean section, visual analogue scale (VAS) scores before and after epidural, APGAR score, maternal and fetal side effects, and satisfaction of pregnant women were evaluated. Results: It was seen that VAS scores were 2-3 with our painless labor analgesia protocol, caesarean rate was 2% among 153 labourers, the hypotension rate was 3.9% as a material side effect, the pregnancy satisfaction rate and the rate of requesting another epidural were 85.6%, and the 1st- and 5th-minute APGAR scores were 9-10 without any adverse effects. Conclusion: Epidural analgesia is a method that should be applied with a multi-disciplinary approach by experienced practitioners and obstetricians. This method dramatically reduces both the pain and stress of the mother and increases labour comfort, and we recommend it to all eligible pregnant women for a painless vaginal delivery.

Benefits of yoga in pregnancy: a randomised controlled clinical trial.

Modern obstetrics confronts a rise in caesarean sections (CS). Prevention of unnecessary primary CS is a global priority. Women face intense psychological and physiological challenges during childbirth. Fear and anxiety during labour reduce women's self-confidence and empowerment. Yoga is a body-mind practice that lowers maternal fear and anxiety and helps relax pelvic floor muscles during labour. The study examined whether yoga practice in pregnancy influences CS rate in primiparous singleton pregnant women, labour pain intensity and epidural analgesia requests at delivery ward admission. We conducted a single-blind, randomised, controlled clinical trial comparing yoga to standard obstetric care in pregnancy. A total of 214 participants were randomised, 106 in yoga and 108 in controls. Weekly 90-min yoga classes were led by a certified yoga teacher's supervision. Every pregnant woman in the interventional group completed 12 yoga sessions. Yoga group had a lower total CS due to less frequent In-labour CS (p=0.004) and a higher rate of spontaneous vaginal birth (p=0.009). They experienced less pain intensity during labour (p<0.001), and there was no difference in epidural analgesia requests. Engaging in yoga during pregnancy reduces the rate of In-labour CS, decreases discomfort and encourages spontaneous vaginal birth in primiparous singleton pregnant women.

Infrared thermographic assessment of cutaneous temperature changes during labour epidural analgesia initiation: An observational pilot study

BackgroundInadequate labour epidural analgesia within 30––45 min of insertion is typically considered primary epidural failure and deemed unsuccessful. Early prediction of analgesic success would have clinical benefit, enabling corrective interventions. Sympathectomy accompanying a successful epidural block can cause foot temperature changes. We sought to evaluate the relationship between foot temperature changes and successful epidural, defined as adequate analgesia in 45 min of epidural administration. For the purpose of this study, we defined primary epidural failure as inadequate analgesia within 45 min of administration. MethodsFollowing ethical committee approval, this observational study was conducted in a tertiary level obstetric centre between January 2021 and March 2024. Patients attending for induction of labour were included; with labour epidural analgesia comprised the epidural study group and without acted as a control group. A FlirT540 infrared thermography camera was used to take bilateral foot images every 5 min for 30 min. Images were taken following epidural administration in the epidural group and at any convenient time once in established labour in the control group. We studied temperature changes over time in the epidural and control groups and compared the temperature changes in patients with successful and failed epidurals. ResultsThirty eight patients were included in the epidural group and eleven in the control group. 29 patients (76.3 %) had successful analgesia and 9 patients (23.7 %) had primary epidural failure. Patients with successful analgesia had a statistically significant rise in temperature after 10 min. The maximum rate of rise was between 5 and 15 min and was 0.5 (0.1)°C per minute on both sides. Primary epidural failure was associated with minimal temperature changes, while all patients who had a 2 °C rise in hallux temperature at 10 min had successful analgesia. ConclusionsSympathetic blockade associated with a successful analgesic epidural block produces cutaneous temperature elevation at the plantar surface of the hallux. These can be detected within ten minutes of instituting an epidural and have a potential role in guiding timely troubleshooting of an epidural.

Impact of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine combination for epidural labour analgesia on neonatal outcomes: a pilot randomised clinical trial

ObjectiveTo investigate the impact of dexmedetomidine-ropivacaine combination versus sufentanil-ropivacaine combination for epidural labour analgesia on neonatal and maternal outcomes and test the feasibility of a future large, randomised trial.DesignA randomised,...

Letter in response to: “Upper back, neck and shoulder pain during labor epidural analgesia: a quality improvement initiative”

Letter in response to: “Upper back, neck and shoulder pain during labor epidural analgesia: a quality improvement initiative”

Optimal Programmed Intermittent Epidural Bolus Interval Timing When Using 10 mL of 0.1% Ropivacaine and 0.5 mcg/mL Sufentanil for Labor Analgesia in Patients Without Breakthrough Pain: A Prospective, Randomized Study.

Interval time, defined as the period of time that effective analgesia can be achieved without the need for patient-controlled epidural analgesia (PCEA), has been investigated as an important parameter for the design of programmed intermittent epidural bolus (PIEB) approaches to labor analgesia. PCEA approaches offer flexibility in the management of labor-related pain while minimizing the risk of patient overdose. Here, the optimal interval between PIEB boluses of 0.1% ropivacaine and 0.5μg/mL sufentanil was evaluated while using revised criteria to define effective analgesia that allowed for the administration of a rescue PCEA bolus during these intervals. Participants were assigned at random to five different groups with PIEB intervals that ranged from 35 to 55minutes. Labor epidural analgesia was initiated by administering 15mL of 0.1% ropivacaine with 0.5μg/mL sufentanil over a 2-minute period. Analgesia was considered effective if there was no additional requirement for manual analgesia or an additional PCEA bolus beyond a maximum of one PCEA bolus between intervals during the first stage of labor. Probit regression analyses were used to estimate the effective PIEB intervals that achieved 50% (EI50) and 90% (EI90) success rates in patients. The final analysis included 142 patients who underwent PIEB for maintaining analgesia during labor. Intervals of 55, 50, 45, 40, and 35minutes were associated with analgesia efficacy odds of 82.8% (24/29), 86.2% (25/29), 96.3% (26/27), 100% (29/29), and 100% (28/28), respectively. The respective EI50 and EI90 intervals associated with patients not suffering from breakthrough pain were 62.9 (95% CI 57.2-91.8) and 50.4 (95% CI 45.3-54.9) minutes. Under the condition of this study, the optimal PIEB interval for the administration of 10 mL boluses of 0.1% ropivacaine and 0.5μg/mL sufentanil is approximately 50minutes.

Advances in Epidural Labor Analgesia for Obese Parturients.

With the development of society and economy, and the improvement of people's living standards, obesity has gradually become a significant issue not only in China but globally. Epidural anesthesia, being the most commonly used method for labor analgesia in clinical practice, has significantly reduced the pain experienced by parturients during childbirth and decreased the cesarean delivery rate. However, due to the anatomical and physiological differences between obese and non-obese parturients, the effectiveness and techniques of labor analgesia may vary. This review focuses on the anatomical characteristics and drug differences in obese parturients, the methods of epidural labor analgesia in this population, the application of ultrasound in epidural puncture for obese parturients, and the complications associated with labor analgesia. The goal is to provide a guidance for clinical practice.

The Association Between Epidural Labor Analgesia and the Fetal Outcome and Mode of Delivery of the Second Twin: A Nationwide Register-Based Cohort Study in Finland

(Int J Obstet Anesth. 2023;56:103924. https://doi.org/10.1016/j.ijoa.2023.103924) Multiple pregnancies carry heightened risk of maternal and fetal health issues, including mortality, compared with singleton pregnancies. However, the perinatal mortality rate for twins in Finland has declined, with rates dropping to 0.7% for the first twin and 1.2% for the second twin in recent decades. While vaginal birth trials are generally safe for twin pregnancies, there remain challenges, especially during the delivery of the second twin, leading to higher complication rates than in singleton births. Epidural analgesia is often beneficial, facilitating obstetric procedures without additional anesthesia, as recommended by the 2019 UK NICE guidelines for reducing emergency cesarean deliveries for the second twin. Despite its advantages, epidural analgesia also poses risks, such as increased chances of operative vaginal delivery and potentially prolonged labor. This study aimed to explore the correlation between epidural analgesia, second-twin delivery mode, and the health outcomes of the second twin.

Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia: a randomised controlled trial.

The dural puncture epidural technique is a modification of the combined spinal-epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal-epidural technique. Term parturients requesting labour epidural analgesia were allocated randomly to receive either dural puncture epidural or combined spinal-epidural. Analgesia was initiated with 2 mg intrathecal bupivacaine and 10 μg fentanyl in parturients allocated to the combined spinal-epidural group and with 20 ml ropivacaine 0.1% with 2 μg.ml-1 fentanyl in parturients allocated to the dural puncture epidural group. Analgesia was maintained using patient-controlled epidural analgesia with programmed intermittent epidural boluses. The primary outcome of the study was the quality of labour analgesia, which was defined by a composite of five components: asymmetric block after 30 min of initiation (difference in sensory level of more than two dermatomes); epidural top-up interventions; catheter adjustment; catheter replacement; and failed conversion to neuraxial anaesthesia for caesarean delivery, requiring general anaesthesia or replacement of the neuraxial block. One hundred parturients were included in the analysis (48 combined spinal-epidural, 52 dural puncture epidural). There were no significant differences between the two groups in the primary composite outcome of quality of analgesia (33% in the combined spinal-epidural group vs. 25% in the dural puncture epidural group), risk ratio (95%CI) 0.75 (0.40-1.39); p = 0.486. Median (IQR [range]) pain scores at 15 min were significantly lower in patients allocated to the combined spinal-epidural group compared with the dural puncture epidural group (0 (0-1[0-8]) vs. 1 (0-4 [0-10]); p = 0.018). There were no significant differences in the quality of labour analgesia following initiation of a combined spinal-epidural compared with a dural puncture epidural technique.

Labor epidural analgesia among Han and Uyghur parturients: a prospective observational study in China

BackgroundDisparities in pain sensitivity and tolerance have been described, however little is known about variability in the experience of labor pain and childbirth in China. MethodsThis prospective observational study was conducted at a tertiary hospital in Xinjiang, China with two major ethnic groups: Han and Uyghur women. Women with a vaginal delivery with labor epidural analgesia were enrolled. The primary outcome was cervical dilation at labor epidural analgesia request, and multivariable linear regression analysis was performed to determine associated variables. Secondary outcomes were pain score at epidural request and epidural analgesics use. Data presented as mean ± standard deviation. ResultsCervical dilatation at labor epidural analgesia request was significantly lower (1.2 ± 0.7 vs. 0.8 ± 0.6 cm; p = 0.0095), and pain score (numerical pain scale 0–10) was significantly higher (0.8 ± 1.0 vs. 4.2 ± 1.2; P = 0.0002) among Uyghur compared to Han women. In the multivariate model, Uyghur women had a lower cervical dilation (p = 0.0392) and a higher pain score (P <0.0001) at epidural request. During the labor process, a larger proportion of Uyghur women used the patient-controlled epidural analgesia (PCEA) pump (77.8% vs. 53.6%, P = 0.0011). They pressed the pump in a significantly shorter time (61.3 ± 41.2 vs. 104.0 ± 105.2 min, P = 0.0015) and for more times (1.9 ± 1.7 vs. 1.2 ± 1.4, P = 0.0022), contributing to significantly more epidural analgesic use (sufentanil: 0.06 ± 0.02 vs. 0.07 ± 0.03 μg/kg/h, P = 0.0150, ropivacaine: 0.11 ± 0.04 vs. 0.14 ± 0.06 mg/kg/h, P = 0.0003, respectively). ConclusionsOur findings suggest that Uyghur women experience labor pain with higher levels of pain and with higher use of epidural analgesics than Han women. Further studies are needed to evaluate whether these differences are clinically relevant.

Uterine contraction frequency after initiation of labour epidural analgesia using electrohysterography monitoring: A prospective pilot study

BackgroundThe introduction of electrohysterography into clinical practice provides new opportunities to study the impact of labour epidural analgesia on uterine contractility because electrohysterography has a greater sensitivity in detecting uterine contractions than external tocodynamometry. We determined the uterine contraction frequency before and after initiation of labour epidural analgesia using an electrohysterography-derived tocogram. MethodsThis prospective study included 23 pregnant women between 36–42 weeks’ gestation with a singleton cephalic presentation who requested epidural analgesia in active labour. The primary study outcome was the difference in mean uterine contraction frequency 60 min before and 120 min after epidural analgesia initiation. The secondary aim was to measure changes in mean contraction frequency over time, using the mean uterine contraction frequency per 10 min, derived from 30-minute averages. ResultsIn the 120 min after epidural analgesia initiation, the average contraction frequency decreased significantly (−0.37 contractions/10 min [95 % CI −0.64 to −0.11]; p = 0.007 compared to the 60 min before epidural analgesia initiation. The largest decrease occurred 60–90 min after epidural analgesia initiation (−0.47 contractions/10 min [95 % CI −0.89 to −0.05]; p = 0.029). ConclusionDuring active labour, electrohysterography identified a statistically significant, although clinically small, reduction in uterine contraction frequency after epidural analgesia initiation. This pilot study demonstrates the potential value of electrohysterography monitoring for obstetric anaesthesia research and might renew interest in the still poorly understood interaction between labour epidural analgesia and uterine activity.

Comparative Study Of Fentanyl Versus Tramadol As Adjuvant With Low Dose Local Anaesthetic Ropivacaine (0.1%) For Epidural Labour Analgesia

Background: Epidural nerve block is widely used for labor analgesia because of its effective pain relief, reduced maternal stress response, improved parturient satisfaction, and potential ability to provide anesthesia. The quality of analgesiais improved with the combined use of a local anesthetic and an opioid when combined with the use of either agent alone. An example of avcombination epidural therapy that provides excellent sensory block with relatively little motor block includes a co-administration of ropivacaine and fentanyl or tramadol. Materials and Methods: The study was carried out at the Department of Anaesthesiology, Katihar Medical College &amp; Hospital, Katihar, Bihar, study was done for 1 Year, 100 individuals were enrolled, Group F (Fentanyl Group) with 50 patients received Ropivacaine and Fentanyl and Group T (Tramadol Group) with 50 patients received a Ropivacaine and Tramadol. Every variable was subjected to statistical analysis within the same individual and between 2 treatment categories using a suitable biostatistical methodology. Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 23.54±2.5, mean age in group T (ropivacaine with tramadol) was 23.86±2.17, and weight in group F was 56.78±2.75 and group T was 56.68±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (p&gt;0.05). More side effects were seen in group F. Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

Exploration of the optimal programmed intermittent epidural bolus volume with the dural puncture epidural technique for labour analgesia: a biased-coin up-and-down sequential allocation study.

To determine the optimal programmed intermittent epidural bolus (PIEB) volume for providing effective analgesia in 90% of patients (EV90) during the first stage of labour using the dural puncture epidural (DPE) technique to initiate labour analgesia. We conducted a biased-coin up-and-down sequential allocation study. We included 40 nulliparous women requiring epidural labour analgesia. We used a 25G Whitacre spinal needle to puncture the dural mater and then administered a loading dose of 12mL of ropivacaine 0.1% and sufentanil 0.3μg·mL-1. Subsequently, the PIEB pump delivered boluses with an identical solution at a fixed 40-min interval, starting 1hr after epidural initiation. The bolus volume for the first patient was 7mL and was adjusted for subsequent patients according to the study protocol (bolus volume, 7-12mL). The primary endpoint was effective analgesia, indicated by no need for patient-controlled or manual boluses within 6hr after analgesia initiation or until complete cervical dilation, whichever came first. Outcome evaluators assessed the patients' pain ratings, Bromage scores, sensory blockade level, and maternal blood pressure hourly. Using the truncated Dixon and Mood method, the estimated EV90 was 9.2mL (95% confidence interval [CI], 8.5 to 9.9) whereas the isotonic regression method yielded a value of 8.8mL (95% CI, 8.6 to 9.8). None of the patients experienced a motor block. Two patients experienced hypotension without the need for vasopressors. The estimated PIEB EV90 for ropivacaine 0.1% and sufentanil 0.3μg·mL-1 approached 9mL when DPE was combined with a fixed 40-min interval. ChiCTR.org.cn ( ChiCTR2300067281 ); first submitted 3 January 2023.