The Labor Analgesia Requirements in Nulliparous Women Randomized to Epidural Catheter Placement in a High or Low Intervertebral Space

Anesthesia and Analgesia
Albert MooreWilliam Li Pi Shan

Abstract

We hypothesized that an epidural catheter placed in a lower vertebral interspace will require less medication for labor analgesia. Nulliparous women requesting neuraxial labor analgesia were randomized to epidural catheter placement at the ultrasound-confirmed L1-2 or L4-5 interspace. Patient-controlled epidural analgesia and breakthrough manual epidural boluses of 10 mL of 0.125% bupivacaine with 50 µg of fentanyl or 8 mL of 2% lidocaine were utilized. Abdominal and perineal pain scores were assessed at 30 and 60 minutes after standardized initiation of epidural analgesia. Pain scores during pushing were assessed after delivery. The primary outcome was the proportion of patients requiring manual boluses and was compared using a χ test. Secondarily, we analyzed the number of boluses given in early (up to 4 hours before delivery) versus late labor using χ tests and the pain scores using Mann-Whitney U tests, with adjustment of P values for multiple testing. We analyzed 148 patients. Overall, the percentage of patients in the low versus high groups who required manual boluses was 46% vs 51% (P = 1.0). For the 56 patients in each group who delivered vaginally, 22 (52%) vs 20 (48%) manual boluses were given to the low epidural grou...Continue Reading

Associated Clinical Trials

References

Jan 1, 1975·British Journal of Anaesthesia·A GalindoJ J Bonica
Jan 1, 1985·Acta Obstetricia Et Gynecologica Scandinavica·J Langhoff-Roos, G Lindmark
Feb 1, 1985·Perceptual and Motor Skills·Y Rofé, D Algom
May 24, 2000·Controlled Clinical Trials·D M ReboussinK K Lan
Nov 9, 2000·Anaesthesia·C R BroadbentR Russell
Oct 22, 2002·American Journal of Obstetrics and Gynecology·Jun ZhangMichael K Yancey
Aug 24, 2004·International Journal of Obstetric Anesthesia·M Arakawa
Mar 6, 2008·Anesthesiology Clinics·Jose Carlos Almeida Carvalho

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Citations

Mar 16, 2018·Current Opinion in Anaesthesiology·Mitko KocarevRoshan Fernando
Jul 12, 2018·Current Opinion in Anaesthesiology·Ki Jinn Chin

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