Labor Analgesia Research Articles

Patient perception of consent processes for epidural analgesia in induction of labour: a qualitative study.

Women undergoing induction of labour often utilise epidural analgesia. Obtaining consent for labour epidural presents a unique challenge for the obstetric anaesthetist, who must comply with the legal standards of consent. This study explores how women perceive the consent process for epidural analgesia during induction of labour. This was a qualitative, single-centre, interview-based study. Fourteen women who received an epidural for labour analgesia were interviewed using a semi-structured interview guide. Data were analysed using thematic analysis. Four themes described women's experience of the consent process. Understanding alternatives, risks and benefits; for example, time constraints hindering the effective communication of information around epidural analgesia, including alternative analgesic options. Timing of information; for example, the value of information was diminished by pain, fatigue and the imminence of the procedure. Timing of consent; for example, physiological and psychological demands of labour negatively impacted patients' ability to engage with the consent process. Anaesthetists' assessment of patient understanding; for example, confirmation of patient understanding by anaesthetists was lacking. Women's experiences of the consent process for induction of labour suggest that in the context of the pain and exhaustion of labour, inadequate and untimely information provision and dialogue between women and their anaesthetists can undermine the implementation of lawful consent.

Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: a prospective, double-blinded, randomised clinical trial.

Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: a prospective, double-blinded, randomised clinical trial.

Epidural labor analgesia is a potential risk factor for increased blood loss within two hours after delivery in women with gestational hypertension: a retrospective cohort study

BackgroundPostpartum hemorrhage remains the leading cause of maternal mortality during childbirth worldwide. Given that pregnant women with gestational hypertension are particularly vulnerable to blood volume reduction, there is currently insufficient evidence to determine whether epidural labor analgesia impacts these patients within the first 2 h postpartum.MethodsA retrospective cohort study was conducted involving 1,903 term parturients with hypertensive disorders of pregnancy admitted to Guangdong Women and Children Hospital between January 2012 and December 2021. Participants were categorized into two groups based on receipt of epidural labor analgesia: the analgesia group (n = 884) and non-analgesia group (n = 1,019). Primary outcomes included early postpartum hemorrhage (PPH) defined as ≥ 300 mL blood loss within 2 h post-delivery and associated risk factors. Statistical analyses were performed using chi-square tests for categorical variables, Mann–Whitney U tests for continuous variables, and multivariate logistic regression to evaluate independent associations between epidural analgesia and PPH.ResultsResults showed significantly higher 2-h postpartum blood loss ≥ 300 mL in epidural analgesia vs non-analgesia groups among gestational hypertension patients (54.0% vs 46.0%, P = 0.003). Multivariate analysis identified epidural analgesia as an independent risk factor for postpartum hemorrhage (adjusted OR = 1.304, 95% CI:1.013-1.680, P = 0.039). Obstetric complications including placental adhesion (OR = 2.405) and macrosomia (OR = 2.644) also correlated with hemorrhage risk (all P < 0.05). Birth canal injury demonstrated a protective association (adjusted OR = 0.63, 0.49–0.81, P < 0.001).ConclusionEpidural labor analgesia may elevate the risk of early postpartum hemorrhage (≤ 2 h) in parturients with gestational hypertension. Clinical practice should prioritize intensive postpartum surveillance and individualized analgesic protocols to balance analgesic efficacy and hemorrhagic risk.

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

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

Environmental and occupational risks with use of nitrous oxide (Entonox®) for labour analgesia: a qualitative analysis of midwives' attitudes in the United Kingdom.

Environmental and occupational risks with use of nitrous oxide (Entonox®) for labour analgesia: a qualitative analysis of midwives' attitudes in the United Kingdom.

Exploration of fever characteristics in parturients under continuous temperature monitoring during labor analgesia and analysis of the impact on maternal and neonatal outcomes: an observational study

ObjectiveBy continuous core temperature monitoring, this study aims to explore the patterns of fever in parturients receiving labor analgesia and analyze its impact on both the maternal and neonatal.MethodsNon-invasive temperature monitoring sensors (iThermonitor705) and labor analgesia temperature management system were used to collect temperature data from parturients. Based on the presence or absence of fever during the peripartum period, the subjects were divided into a fever group and a non-fever group. Maternal temperature data during the peripartum period, along with maternal and neonatal demographic and clinical characteristics, were collected.ResultsAmong the parturients receiving labor analgesia, 25.9% (43/166) developed a fever during the peripartum period. Of these, 25.6% (11/43) experienced their first fever after delivery, all occurring within 2 h after delivery. Compared to the non-fever group, the fever group had longer durations of the first stage of labor, total labor duration, and epidural analgesia. Additionally, the fever group had a higher rate of meconium-stained amniotic fluid (grade III), used more analgesics, and had a higher rate of antibiotic use. However, no significant differences in adverse maternal and neonatal outcomes were observed between the two groups.ConclusionFever can occur not only during labor but also for the first time after delivery. Although fever during the peripartum period increases the rate of maternal exposure to antibiotics, there were no significant differences in maternal or neonatal outcomes between the two groups.

Effects of dezocine with ropivacaine on epidural analgesia during labor: a randomized controlled trial

BackgroundAdding μ-opioid receptor agonists to local anesthetics are usually used for labor analgesia, while they are associated with pruritus. Kappa opioid agonists (dezocine) are widely used for pain management. Recently, they have emerged as a novel type of potent antipruritic agents. The purpose of this study was to investigate the effects of dezocine with ropivacaine on epidural analgesia during labor.MethodsA total of 120 parturients were randomly divided into two groups (60 cases each). The group D received 0.1% ropivacaine with dezocine 0.2 mg/mL for epidural analgesia while the control group received 0.1% ropivacaine with sufentanil 0.4 μg/mL for epidural analgesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were monitored. The onset time and duration of analgesia, pain intensity, Bromage scores, delivery outcome, neonatal Apgar scores, and adverse events of mothers and neonates were recorded. Pain intensity was assessed using visual analogue scale (VAS). Umbilical arterial blood was collected for analysis.ResultsThe incidence of itching was lower in the group D than the control group (0% vs. 10%, P = 0.036). The duration of analgesia was longer in the group D (76.1 ± 9.7 vs. 72.1 ± 10.5 min, P = 0.032), and numbers of boluses were fewer in the group D (median, 2 vs.3, P = 0.018). The onset time of analgesia and VAS values were similar between the two groups (all P &amp;gt; 0.05). There were no significant differences in terms of hypotension, bradycardia, motor block, respiratory depression, fetal acidosis, nausea and vomiting between the two groups.ConclusionThis study indicated that the epidural use of dezocine increased the analgesic effect, prolonged the duration of analgesia and decreased the incidence of itching during labor without increasing adverse events of mothers and neonates.Clinical Trial Registrationhttps://www.chictr.org.cn, identifier ChiCTR2000035341.

Evaluation of the Efficacy of Intravenous Infusion of 1000 mg Paracetamol as Intrapartum Labor Analgesia

ABSTRACT Background: It is vital to assess methods of reducing the most severe labor pain. Paracetamol infusion is an efficient therapy available to eliminate labor pain in the active phase. Aim: The present study aimed to assess the efficacy of intravenous infusion of 1000 mg paracetamol as an intrapartum labor analgesic. Methods: In 220 nulliparous pregnant females undergoing vaginal delivery, after active labor phase onset, subjects were divided into two groups. Group I subjects were given 300cc normal saline and Group II subjects were given 300cc normal saline and 1 gram paracetamol. In two groups, Apgar scores, delivery type, duration of first and second labor stages, VAS scores, and maternal pain scores were assessed and compared. Results: Mean first- and second-stage labor length was significantly lower in Group I compared to Group II with P = 0.001 and 0.037. Also, mean pain scores were significantly lower in paracetamol Group II compared to a control group with P &lt; 0.05. Conclusions: Intravenous paracetamol prescription not only reduces labor pain in pregnant females but also decreases the duration of different labor stages, reduces the need for cesarean birth, and increases patient satisfaction with natural childbirth.

Comparison of motor block in continuous epidural infusion &lt;i&gt;vs&lt;/i&gt; intermittent epidural bolus using bupivacaine with fentanyl for labour analgesia

This study aimed to compare the motor blocking effect of Continuous Epidural Infusion (CEI) vs Intermittent Epidural Bolus (IEB) for labour analgesia using bupivacaine 0.0625% and fentanyl 4 μg/ml. Sixty primigravida patients were divided into groups of 30 that received a loading dose of 10 ml of 0.0625% bupivacaine and 4 μg/ml fentanyl in 5 ml with subsequent continuous infusion or intermittent boluses. Motor block level, blood pressure, heart rate, pain severity, maternal satisfaction, and neonatal Apgar scores were noted. All 60 participants completed the study. There were no statistical differences between the groups in Bromage score (p-value=0.837), Visual Analog Scale (VAS) (p-value=0.482). The incidence of hypotension was 15% and 0% in groups I and II, with a p-value of 0.036. APGAR scores were &gt;7 in both groups. Analgesia was rated satisfactory by 70% and 63% of the participants in groups I and II, respectively (p&lt;0.736). Labour analgesia was achieved with a minimal motor block in both groups. Hemodynamic parameters, pain score, Apgar scores, and maternal satisfaction were similar in both groups.

Obstetric Anesthesia Workforce Survey: 40-year Update.

For 40 years, Obstetric Anesthesia Workforce Surveys have been used every decade to assess trends in obstetric anesthesia practice and potential areas for improvement. Anesthesia providers from U.S. hospitals were surveyed in 2022-2023 and provided data for their hospital from 2021. Our primary hypothesis was that obstetric anesthesia services have changed in the last decade. Previous workforce surveys were used to develop the 32-question survey about contemporary obstetric anesthesia practice. A hospital sample (n= 1,180) was generated based on number of births per year and U.S. census region. Using web-push survey methodology, a QR code was assigned to the "Chief of Anesthesiology" at each hospital. A link to an online REDCap survey was emailed to individuals along with reminder communications. Nonresponding hospitals received paper surveys and self-addressed stamped envelopes for survey return. Results were analyzed using R statistical package at a significance level of p<0.05. There were 284 (24%) responses to the survey. Hospitals providing obstetric care have decreased 50% over 4 decades. Seventy-seven percent of respondents work in non-academic hospitals without residency programs. Comparing academic to non-academic hospitals, academic providers are less likely to have other clinical responsibilities, 35% vs 62% respectively. The weighted overall rate of neuraxial labor analgesia is 84%. Elective cesarean deliveries are usually performed with spinal anesthesia (85%). Neuraxial anesthesia is used in 86% of urgent cesareans while 14% use general anesthesia. This is the only study that reports longitudinal obstetric anesthesia data over 40 years. Despite stable annual birth rates in the U.S., the number of hospitals providing obstetric care decreased by 50% over the last 40 years. This study describes non-academic practice and not just academic teaching hospitals. Increased access to neuraxial labor analgesia is a dramatic step towards reducing in-hospital maternal mortality and improving health care disparities.

Horner's syndrome following epidural analgesia for labour

Horner's syndrome is a rare complication of epidural analgesia, likely due to the cephalad spread of anaesthetics. We report a 30-year-old woman who developed Horner's syndrome 25 minutes after receiving an epidural, showing unilateral arm weakness, ptosis, miosis, and conjunctival hyperaemia. The symptoms resolved in 2.5 hours with no post-partum neurological deficits. While persistent symptoms may require further investigation, unnecessary imaging and treatment can be avoided. This case emphasizes the importance of recognizing this rare complication to obstetric anaesthesia.

Programmed Intermittent Epidural Bolus (PIEB) Versus Patient-Controlled Epidural Analgesia (PCEA) with Continuous Basal Infusion for Labor Analgesia: A Meta-Analysis

Background: Maintaining effective labor epidural analgesia while optimizing maternal satisfaction and minimizing drug consumption remains a key objective in obstetric anesthesia. Programmed intermittent epidural bolus (PIEB) techniques have emerged as an alternative to traditional continuous epidural infusion (CEI) combined with patient-controlled epidural analgesia (PCEA). This meta-analysis aimed to compare the efficacy, local anesthetic (LA) consumption, and maternal satisfaction between PIEB regimens (typically combined with PCEA for rescue) and PCEA regimens supplemented with a continuous basal infusion (PCEA+Basal). Methods: A systematic literature search was conducted for PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) published between January 2013 and December 2024 comparing PIEB (+/- PCEA) with PCEA+Basal for labor analgesia. Primary outcomes were hourly LA consumption, maternal satisfaction (rated as high/excellent), and need for clinician rescue analgesia (breakthrough pain). Secondary outcomes included pain scores (Visual Analog Scale - VAS), mode of delivery, duration of labor stages, motor blockade incidence, and neonatal outcomes (Apgar scores). Data were extracted from suitable studies identified through the search. A random-effects model was used for meta-analysis using RevMan software. Mean Differences (MD) or Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic. Results: Five studies involving a total of 1158 parturients met the inclusion criteria. The pooled analysis indicated that PIEB regimens were associated with a trend towards lower hourly LA consumption compared to PCEA+Basal (MD: -1.2 mL/hour; 95% CI: -2.5 to 0.1; P=0.07; I²=78%), although heterogeneity was high. Maternal satisfaction rated as 'high' or 'excellent' was significantly more frequent in the PIEB group (OR: 1.85; 95% CI: 1.20 to 2.85; P=0.005; I²=35%). The need for clinician rescue analgesia was numerically lower with PIEB, but the difference did not reach statistical significance (OR: 0.70; 95% CI: 0.45 to 1.10; P=0.12; I²=45%). No significant differences were noted in VAS pain scores during established labor, mode of delivery, or Apgar scores. Incidence of motor block appeared potentially lower with PIEB regimens. Conclusion: Based on this meta-analysis, PIEB regimens appear promising for labor analgesia, potentially offering comparable efficacy to PCEA+Basal while possibly reducing local anesthetic consumption and enhancing maternal satisfaction. However, significant heterogeneity was observed for some outcomes. High-quality, large-scale RCTs directly comparing optimized PIEB+PCEA protocols with PCEA+Basal infusion are crucial to definitively establish the relative benefits and risks of these techniques.

Remifentanil Patient-Controlled Analgesia for Labor Analgesia at Different Cervical Dilations: A Single Center Retrospective Analysis of 1045 Cases.

Background and Objectives: Remifentanil is a potent synthetic μ-opioid receptor agonist known for its rapid onset and ultrashort duration of action, making it a popular choice for intravenous labor analgesia. The analgesic effectiveness of remifentanil patient-controlled analgesia (Remifentanil-PCA) may vary based on the stage of labor and parity, potentially influencing satisfaction with labor analgesia. This study aimed to evaluate the degree of pain reduction achieved with remifentanil-PCA, considering different cervical dilations in both nulliparous and multiparous women. Material and Methods: Women who were ≥37 weeks pregnant with singleton cephalic fetuses, either by spontaneous onset or induction of labor, were included in the study. Data were collected from the Labor Record form, which included demographic and obstetric information, as well as the onset of analgesia categorized by cervical dilation (1-3 cm, 4-6 cm, 7-9 cm, and full dilation). Additionally, data on analgesia onset and duration (the time interval between the start of analgesia and the delivery of the baby), initial numerical rating scale (NRS0) for pain intensity, NRS after the first hour of analgesia (NRS1), the lowest recorded NRS during labor (NRSmin), and pain reduction during the first hour of analgesia (NRS0-VAS1), satisfaction with labor analgesia (rated 0 for dissatisfied, 1 for moderately satisfied, 2 for very satisfied), and complication rates were obtained from the remifentanil-PCA form. Results: A total of 513 nulliparas and 523 multiparas who gave birth between 1 January 2019 and 31 December 2019 were reviewed. No significant differences were found between the two groups regarding age, body mass index, labor induction rates, occipito-posterior positioning, blood loss > 500 mL, or neonatal outcomes. Nulliparas exhibited a higher gestational age (p = 0.021), longer labor duration (p < 0.001), and increased rates of cesarean sections (p < 0.001) and vacuum extractions (p = 0.002). Remifentanil-PCA consistently provided mild to moderate pain intensity reduction. No differences were found in VAS0, VAS1, or pain intensity reduction (VAS0-VAS1) regardless of the stage of labor or parity. Significant differences in VAS min were observed among nulliparas at different stages of labor (p < 0.026). However, a higher proportion of multiparas reported moderate (24.7% vs. 9.5%, p < 0.001) and high satisfaction (90% vs. 75%, p < 0.001) with remifentanil-PCA compared to nulliparas. Importantly, no serious complications in mothers or neonates attributed to remifentanil-PCA were observed during the observational period. Conclusions: Remifentanil-PCA demonstrates consistent effectiveness regardless of the stage of labor or parity. This indicates that remifentanil-PCA can be administered at any point during labor. Coupled with its rapid availability and immediate analgesic effect, this feature enhances the flexibility of its use in clinical practice.

Neuraxial analgesia in labour – initiation and maintenance techniques

Neuraxial analgesia in labour – initiation and maintenance techniques

Non-neuraxial analgesia in labour

Non-neuraxial analgesia in labour

Intrathecal catheter after accidental dural puncture in obstetric patients: Safety and effectiveness reducing post-dural puncture headache.

Intrathecal catheter after accidental dural puncture in obstetric patients: Safety and effectiveness reducing post-dural puncture headache.

Effect of epidural labour analgesia on gastric emptying during labour: A prospective controlled study.

Effect of epidural labour analgesia on gastric emptying during labour: A prospective controlled study.

Continuous epidural infusion versus programmed intermittent epidural bolus for labor analgesia and vacuum-assisted vaginal delivery rates: A retrospective cohort study (2020–2021)

Continuous epidural infusion versus programmed intermittent epidural bolus for labor analgesia and vacuum-assisted vaginal delivery rates: A retrospective cohort study (2020–2021)

Neuraxial initiation techniques for labor analgesia: Comparative insights on standard epidural, combined spinal-epidural and dural puncture epidural analgesia.

In recent years, initiation techniques for neuraxial labor analgesia have focused on enhancing analgesic quality while minimizing complications. This review aims to summarize recent evidence on the standard epidural (EPL), combined spinal-epidural (CSE), and dural puncture epidural (DPE) techniques, emphasizing their benefits, risks, and relevance in contemporary obstetric anesthesia care. The DPE technique offers unique values, combining the advantages from CSE and EPL techniques. DPE and CSE, compared with EPL, techniques involve a dural puncture with a spinal needle, and the resulting epidural-intrathecal conduit enables translocation of analgesic agents, providing faster onset, earlier sacral coverage, better catheter function, and more rapid epidural extension to surgical anesthesia. Moreover, by limiting the intrathecal dose administered with the CSE technique, the DPE technique lowers the risks of fetal bradycardia and pruritus. EPL and CSE techniques are widely used for neuraxial labor analgesia. The DPE technique offers a novel alternative, delivering high-quality analgesia with minimal complications. While the benefits of the DPE technique are increasingly being recognized, additional comparative research will better support anesthesiologists in selecting the most appropriate technique across diverse clinical scenarios.

Epidural volume extension versus dural puncture epidural analgesia for labor: A prospective randomized study.

Providing effective labor analgesia is very important for maternal and infant safety. Various neuraxial techniques are used for this purpose. Our objective was to compare the epidural volume extension (EVE) and dural puncture epidural (DPE) procedures employed in clinical practice for labor analgesia, focusing on labor parameters, pain levels, fetal outcomes, and complications. Sixty patients were randomized to EVE (n = 30) and DPE (n = 30). In the EVE group, 1 mL of a mixture containing a combination of 10 µg fentanyl and 0.25% isobaric bupivacaine was injected into the intrathecal region via a 25-G 120 mm Whitacre spinal needle. Then, 7.4 mL of 0.9% NaCl was injected into the epidural area. In the DPE group, after dural puncture with the same procedure, 20 mL of a mixture containing a combination of 2 µg/mL fentanyl and 0.125% isobaric bupivacaine was injected into the epidural area. Time of required the first top-up dose, numerical pain rating scale ≤ 1 and bilateral S2 block time, sensory block level, number of top-up doses required during labor, incidence of complications were recorded. A total of 60 patients were analyzed. First top-up time-the primary outcome of the study, was similar between groups (76.45 ± 17.38 vs 88.20 ± 31.38, P = .067). Time to reach minimum pain score, numerical pain rating scale ≤ 1, bilateral S2 block time was significantly shorter in group EVE compared to group DPE. There was no statistical significance in terms of peak dermatome level and total number of administered top-ups, time to reach peak dermatome, incidence of complications. While the EVE technique necessitates a reduced total volume of local anesthetic, it results in a more rapid ascent of the dermatomal level and a quicker reduction in pain scores; we believe that both strategies can be utilized effectively and safely for labor analgesia. However, randomized comparative studies with larger sample sizes are required to find the optimal strategy.