Influence Of Epidural Analgesia Research Articles

Influence of opioid analgesia type on circulating tumor cells in open colorectal cancer surgery (POACC-1): study protocol for a prospective randomized multicenter controlled trial

BackgroundOpioids and epidural analgesia are a mainstay of perioperative analgesia but their influence on cancer recurrence remains unclear. Based on retrospective data, we found that cancer recurrence following colorectal cancer surgery correlates with the number of circulating tumor cells (CTCs) in the early postoperative period. Also, morphine- but not piritramide-based postoperative analgesia increases the presence of CTCs and shortens cancer-specific survival. The influence of epidural analgesia on CTCs has not been studied yet.MethodsWe intend to enroll 120 patients in four centers in this prospective randomized controlled trial. The study protocol has been approved by Ethics Committees in all participating centers. Patients undergoing radical open colorectal cancer surgery are randomized into epidural, morphine, and piritramide groups for perioperative analgesia. The primary outcome is the difference in the number of CTCs in the peripheral blood before surgery, on the second postoperative day, and 2–4 weeks after surgery. The number of CTCs is measured using molecular biology methods. Perioperative care is standardized, and relevant data is recorded. A secondary outcome, if feasible, would be the expression and activity of various receptor subtypes in cancer tissue. We intend to perform a 5-year follow-up with regard to metastasis development.DiscussionThe mode of perioperative analgesia favorably affecting cancer recurrence would decrease morbidity/mortality. To identify such techniques, trials with long-term follow-up periods seem suboptimal. Given complex oncological therapeutic strategies, such trials likely disable the separation of perioperative analgesia effects from other factors. We believe that early postoperative CTCs presence/dynamics may serve as a sensitive marker of various perioperative interventions´ influences on cancer recurrence. Importantly, it is unbiased to the influence of long-term factors and minimally invasive. Analysis of opioid/cannabinoid receptor subtypes in cancer tissue would improve understanding of underlying mechanisms and promote personalization of treatment. We are not aware of any similar ongoing studies.Trial registration numberNCT03700411, registration date: October 3, 2018. Study status: recruiting.

Obstetric anesthesia in China: associated challenges and long-term goals.

Obstetric anesthesia in China: associated challenges and long-term goals.

Using quantile regression to re-evaluate the epidural labor analgesia under new partogram: a prospective cohort study

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression. Methods In this study, we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology, Tongji Medical College, Huazhong University of Science and Technology from May to September, 2018. The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150), and those who were not to the control group (n=150). Labor duration and delivery outcomes were analyzed by Student's t test, Mann-Whitney U test, Chi-square test and Fisher's exact test. Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration. Results The median durations of first- and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min, respectively, which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273, P 0.05). Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor, especially with the first stage of labor, but has no adverse effects on maternal and neonatal outcomes. Key words: Labor, obstetric; Anesthesia, epidural; Labor stage, first; Labor stage, second; Regression analysis; Prospective studies

Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis.

Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. Multicenter retrospective, observational, cohort study. Seventeen French and Belgian ICUs. All patients admitted to with acute pancreatitis between June 2009 and March 2014. The primary exposure was thoracic epidural analgesia versus standard care without epidural analgesia. The primary outcome was 30-day mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. One thousand three ICU patients with acute pancreatitis were enrolled, of whom 212 died within 30 days. Epidural analgesia was used in 46 patients and was associated with reduced mortality in unadjusted analyses (4% vs. 22%; p = 0.003). After adjustment for baseline variables associated with mortality, epidural analgesia was still an independent predictor of 30-day mortality (adjusted odds ratio, 0.10; [95% CI, 0.02-0.49]; p = 0.004). Using propensity score analysis, the risk of all-cause 30-day mortality in patients with acute pancreatitis receiving epidural analgesia was significantly lower than that in matched patients who did not receive epidural analgesia (2% vs. 17%; p = 0.01). Among critically ill patients with acute pancreatitis, mortality at 30 days was lower in patients who received epidural analgesia than in comparable patients who did not. These findings support ongoing research on the use of epidural analgesia as a therapeutic intervention in acute pancreatitis.

Is epidural analgesia during labor related to retained placenta?

To explore the influence of epidural analgesia on the course of the third stage of labor and on the incidence of the complete retained placenta as well as retained parts of the placenta. This is a population-based cohort study in a tertiary medical center. We collected data from all 4227 spontaneous singleton vaginal deliveries during 6 months and compared the incidence of retained placenta in deliveries with epidural analgesia with those without analgesia. Multivariable logistic regression was used to control for possible confounders. More than two-thirds of the women (69.25%) used epidural analgesia during their delivery. A need for intervention due to placental disorder during the third stage of labor was noted in 4.2% of all deliveries. Epidural analgesia appeared to be significantly (P=0.028) related to placental disorders compared with no analgesia: 4.8% vs. 3%, respectively. Deliveries with manual interventions during the third stage, for either complete retained placenta or suspected retained parts of the placenta, were associated with the use of epidural analgesia (P=0.008), oxytocin (P=0.002) and older age at delivery (P=0.000), but when including all factors in a multivariable analysis, using a stepwise logistic regression, the factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and, marginally, older age. Complete retained placenta and retained parts of the placenta share the same risk factors. Epidural analgesia does not directly influence the incidence of complete retained placenta or retained parts, though clinically linked through increased oxytocin use. The factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and older age.

Painless delivery: Yes or no?

Contemporary obstetrics aims to achieve painless delivery, whereby the life of the mother or fetus would not be compromised. Epidural analgesia is nowadays considered to be the method of choice for the labor pain relief. The aim of this paper is to provide an overview of the basic principles and techniques of performing epidural analgesia, its specificities for women in labor, its effects on the mother and fetus, as well as the dilemmas that accompany this method. The specificities of epidural anesthesia in pregnant women, such as soft tissue edema, increased weight, changes in texture ligaments, lumbar lordosis and engorgement of epidural veins, make it more difficult to perform the epidural block in pregnancy. The most important misconception is the influence of epidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. Epidural analgesia is currently the most effective and the safest method of anesthesia delivery.

The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor

BackgroundObjective pain assessment that is not subject to influences from either cultural or comprehension issues is desirable. Analysis of heart rate variability has been proposed as a potential method. This pilot study aimed to assess the performance of the PhysioDoloris™ analgesia monitor which calculates an Analgesia Nociception Index derived from heart rate variability. It was compared with visual analogical pain scores. MethodsForty-five parturients who requested epidural analgesia were recruited. Simultaneous couplets of pain scores and Analgesia Nociception Index values were recorded every 5min regardless of the presence or absence of uterine contractions. The relationship between indices was characterized, and a cut-off value of Analgesia Nociception Index corresponding to a visual analogical score >30 (range 0–100) was used to determine the positive and negative predictive value of the Analgesia Nociception Index. ResultsThere was a negative linear relationship between visual analogical pain scores and Analgesia Nociception Index values regardless of the presence of uterine contractions (regression coefficient±SEM=−0.18±0.032 for entire dataset). Uterine contraction significantly reduced the Analgesia Nociception Index (P<0.0001). Using a visual analogical pain score >30 to define a painful sensation, the lower 95% confidence limit for the Analgesia Nociception Index score was 49. ConclusionThe Analgesia Nociception Index has an inverse linear relationship with visual analogical pain scores. Further studies are necessary to confirm the results of this pilot study and to look at the influence of epidural analgesia on the Analgesia Nociception Index.

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

Epidural analgesia has become the most popular method for labor pain relief. Analgesia in Labor: Yes or No? Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables. Pain and anxiety lead to adrenergic hyperactivity, hyperventilation, hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so pain relief is recommended and even indicated in cases of maternal comorbidity. Analgesia in Labor: Method of Choice. The quality of epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation. Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar lordosis, soft tissue edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural puncture should be performed by medial approach, at L2-3 or L3-4 level by loss of resistance technique between contractions. Epidural Analgesia in Labor: What With? Local anesthetics, bupivacaine, levobupivacaine, ropivacaine, are used and they can be combined with small doses of opioids (fentanyl or sufentanyl). Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal--epidural analgesia. Epidural Analgesia in Labor: Controversies. The most important controversy is the influence ofepidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. Although there still are some difficulties, complications and controversies, epidural analgesia provides safe and effective labor pain control.

Analgesia epidural en obstetricia: ¿cómo afecta al desarrollo y finalización del parto?

Background and objectiveEpidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. Patients and methodsProspectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. ResultsOf a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P<.01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P<.001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2]hours in the epidural group vs 4.7 [3.5]hours in the no-epidural group, P<.01) and of the expulsion phase (1.0 [0.6]hours vs 0.7 [0.6]hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1–1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3–3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9–1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge’s first plane decreased risk 2.7-fold and 3.03-fold, respectively. ConclusionsAlthough epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery.

O915 The influence of epidural analgesia on the course of labor

O915 The influence of epidural analgesia on the course of labor

EPIDURAL ANALGESIA;

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.

The effect of epidural analgesia on labor progress and outcome in nulliparous women

Objective. The present study was designed to investigate the influence of epidural analgesia on labor progress and outcome in nulliparous women.Methods. A population-based study comparing women with and without epidural analgesia was conducted. Deliveries occurred during 1988–2006 at the Soroka University Medical Center. A multivariable logistic regression model with backward elimination was constructed to control for confounders.Results. During the study period there were 39 498 deliveries; epidural analgesia was given in 9960 (25.2%) of these. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age, oligohydramnios, premature rupture of membranes, induction of labor, and Jewish (vs. Bedouin) ethnicity. These patients were more likely to deliver by cesarean delivery (CD; OR = 1.4, 95% CI 1.3–1.5; p < 0.001) and vacuum extraction (OR = 1.5, 95% CI 1.4–1.7; p < 0.001). After controlling for possible confounders such as macrosomia, failed induction, hypertensive disorders, gestational diabetes, maternal age, labor dystocia, and ethnicity, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (OR = 0.9, 95% CI 0.8–0.9; p = 0.038). When vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (OR = 1.1, 95% CI 1.01–1.3; p = 0.04).Conclusions. Epidural analgesia in nulliparous parturients increases the risk for labor dystocia and accordingly is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.

336: The influence of epidural analgesia on mode of delivery in nulliparous women

WOMEN HANNY PAL OHANA, AMALIA LEVY, AMIT ROZEN, YORAM SHAPIRA, LEV GREEMBERG, EYAL SHEINER, Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer-Sheva, Israel, Ben Gurion University of the Negev, Faculty of Health Services, Epidemiology, Beer-Sheva, Israel, Soroka University Medical Center, Ben-Gurion University of the Negev, Division of Anesthesiology, Beer-Sheva, Israel OBJECTIVE: The present study was designed to investigate the influence of epidural analgesia on mode of delivery in nulliparous women. STUDY DESIGN: A population-based study comparing women with and without epidural analgesia was conducted. A multivariable logistic regression model with backward elimination was constructed to control for confounders. RESULTS: During the study period there were 39,498 deliveries, and in 9,960 (25.2%) of these, epidural analgesia was introduced. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age (OR 1.1; 95% CI 1.041.05; P 0.001), oligohydramnios (OR 1.2; 95% CI 1.1-1.4; P 0.004), PROM (OR 1.5; 95% CI 1.4-1.6; P 0.001), and induction of labor (OR 2.2; 95% CI 2.1-2.4; P 0.001). These patients were more likely to deliver by cesarean delivery (CD; 11.4% vs. 8.7%, P 0.001) and vacuum extraction (9.0% vs. 6.1%, P 0.001). However, after controlling for possible confounders such as failed induction, maternal age, etc, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (P 0.038, Table). On the contrary, when vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (P 0.04, Table). CONCLUSION: Epidural analgesia in nulliparous parturients is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.

Epidural analgesia during childbirth

Epidural analgesia is the most effective means of pain relief during labor and is considered to be the "gold standard". For sufficient epidural analgesia, a wide range of nerve-block has to cover the segments Th10 to S4. This article includes the pathophysiological background as well as aspects of risk information and informed consent. Practical issues such as the insertion of the epidural catheter, choice of medication and application modes are described. The influence of epidural analgesia on labor, instrumental delivery and rate of caesarean section is discussed.

Influence of postoperative epidural analgesia with bupivacaine on intestinal motility, transit time, and anastomotic healing.

Epidural application of bupivacaine has been suggested to have a sympatholytic effect on spinal reflex mechanisms that shortens postoperative paralysis and leads to an improved transit time. The influence on anastomitic healing remains controversial. Laparotomy was performed in eight dogs. A short segment of the distal colon was resected and five electrodes were fixed on the serosa to measure the myoelectric activity (e.g., Migrating Myoelectric Complex--MMC). After operation a peridural catheter was placed between L7 and the sacral crest. One milliliter of bupivacaine 0.25% for each 3 kg of body weight was injected every 4 hours. Barium pellets coated in wax were placed into the stomach to allow radiographic representation of transit time. After 5 days the colon anastomosis was resected to measure the bursting pressure. In the peridural analgesia group (PDA) we found one small bowel intussusception and one covered anastomotic leakage. Postoperative PDA led to early and severe myoelectric activity but did not influence the time until the first MMC occurred (44 +/- 0.8 h, PDA; 44.6 +/- 1.5 h,control). Neither the transit time to the colon (50.2 +/- 1.9h, PDA; 51.7 +/- 5.5 h, control) nor the anastomotic healing was influenced (bursting pressure: 176 +/- 21.1 mmHg, PDA; 152 +/- 27.7 mmHg, control). Postoperative epidural analgesia with bupivacaine shortens intestinal paralysis. Early myoelectric activity with a lack of propulsive activity can cause complications like small bowel intussusception. Hence early postoperative enteral nutrition after epidural analgesia is risky. Because the influence of epidural analgesia on propulsive motility remains unclear, it seems reasonable to recommend its limited use in colon surgery.

Epidural analgesia for labour pain: A review of availability, current practices and influence on labour

Summary We performed a review on the availability and current practice of epidural analgesia for labour pain and the influence of epidural analgesia on the outcome of labour. Recent surveys in North America and Europe have shown a trend towards increased labour pain management; no surveys from Africa, Asia, Australia or South America could be identified. Systemic medications remain the most common approach. In most countries, the use of epidural analgesia is steadily increasing with rates of between 14% and 38%, whereas in Hungary and two regions of Italy the epidural rate is below 5%. Twenty-four hour availability was reported more frequently at university hospitals or centres with a high delivery rate, than in smaller hospitals or rural areas. There is an increasing tendency in all countries, for epidural analgesia to be assigned to the responsibility of an anaesthetist. Recent developments, such as low concentrations of local anaesthetics and additional opioids, have become part of clinical practice in some European countries, although there is no data available from other countries, and there is no data on the use of ropivacine or sufentanil. The majority of midwives and obstetricians believe that epidural analgesia prolongs labour and 42% of midwives in the United States agreed that they should discourage its use. Current studies indicate an association between epidural analgesia and increased duration of labour, oxytocin augmentation, instrumental vaginal delivery, dystocia and Caesarean section. It remains unclear whether epidural analgesia causes abnormal labour or merely serves as a marker. Because epidural analgesia is only one of many factors influencing the course of labour, conclusions drawn from research centres may not necessarily apply to other institutions. Each individual hospital and its care providers should monitor their own statistics regarding epidural analgesia and intervention rates.

Influence of epidural analgesia on labor, delivery and early neonatal status and development of newborn

International Journal of Gynecology & ObstetricsVolume 70, Issue S2 p. B109-B109 Poster Antenatal care and diagnosis 2 Influence of epidural analgesia on labor, delivery and early neonatal status and development of newborn S. Tomás, S. TomásSearch for more papers by this author S. Tomás, S. TomásSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)85296-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS22000Pages B109-B109 RelatedInformation

Induction of labour after 1 previous Caesarean section.

The aim of this study was, after induction of labour in women with a previous Caesarean section, to compare the outcome in women with a history of a previous vaginal delivery with women who had never delivered vaginally. A retrospective analysis was performed over a 2-year period, in a Dublin teaching hospital. One hundred and three women who had had 1 previous lower segment Caesarean section had labour induced. Particular attention was given to delivery outcome, history of a vaginal delivery, cervical effacement at induction, influence of epidural analgesia, indication for induction and incidence of uterine rupture. The repeat Caesarean section rate after induction was 20.4%. Of the 51 women who had never previously delivered vaginally, the repeat section rate was 37.3% compared with only 3.9% of the 52 women who had previously delivered vaginally (p < 0.01). Fourteen women who had never delivered vaginally had an uneffaced cervix at induction and the repeat Caesarean section rate in this group was 64.3%. The commonest indication for induction was a postdates pregnancy. The use of epidural analgesia was greater in women who had never delivered vaginally. There were 2 cases of uterine scar rupture. Induction of labour following Caesarean section is associated with a significantly higher incidence of repeat Caesarean section in women who have not had a previous vaginal delivery. If the cervix is not effaced at induction, the repeat Caesarean section rate is higher than if the cervix has started to efface.

The Influence of Epidural Analgesia on Cesarean Delivery Rates: A Randomized, Prospective Clinical Trial

Departments of Obstetrics and Gynecology and Anesthesia, University of Louisville School of Medicine, Louisville, Kentucky Am. J. Obstet. Gynecol., 179: 1527-1553, 1998

The influence of epidural analgesia on cesarean delivery rates: A randomized, prospective clinical trial

Objective: The effects of epidural analgesia on the progress of labor are controversial. The objective of this study was to determine the effect of epidural analgesia on cesarean delivery rates in a population of patients randomly assigned to receive either epidural analgesia or intravenous opioids for intrapartum pain relief. Study Design: From January 1995 to May 1996, 318 spontaneously laboring, term, nulliparous patients were randomly assigned to receive either intravenous opioids or epidural analgesia for pain relief. Labor was managed according to the principles of active management of labor. Cesarean delivery was performed for obstetric indications. Data analysis was conducted on an intent-to-treat basis. A subanalysis was subsequently performed on patients who were compliant with the allocated form of treatment. Results: One hundred sixty-two patients were randomly assigned to receive intravenous meperidine and 156 were randomly assigned to receive epidural analgesia. Maternal age, gravidity, race, gestational age, and cervical dilatation at admission and at first analgesic dose did not differ between the groups. Intent-to-treat data analysis revealed no significant difference in the cesarean delivery rate between the 2 groups, being 13.6% in the opioid group and 9.6% in the epidural group (relative risk 0.70, 95% confidence interval 0.38-1.31, P > .05). Cesarean delivery rates for the indication of dystocia also did not differ, being 10.5% in the opioid group and 5.8% in the epidural group (relative risk 0.56, 95% confidence interval 0.26-1.21, P > .05). Subanalysis of the data from patients who were compliant with the allocated form of treatment revealed that patients in the epidural group (n = 147) were 3 times more likely to have an active phase duration ≥8 hours and were 10 times more likely to require ≥2 hours in the second stage of labor than were those in the opioid group (n = 78). There were no significant differences in cesarean delivery rates in this subanalysis, being 7.7% in the opioid group and 8.8% in the epidural group (relative risk 1.15, 95% confidence interval 0.45-2.91, P > .05). The cesarean delivery rates for dystocia were also similar in the subanalysis, being 3.8% in the opioid group and 5.5% in the epidural group (relative risk 1.42, 95% confidence interval 0.39-5.22, P > .05). Conclusion: Epidural analgesia provides safe and effective intrapartum pain control and may be administered without undesirable effects on labor outcome. (Am J Obstet Gynecol 1998;179:1527-33.)