Epidural versus intravenous analgesia during labour

Canadian Medical Association Journal 1996; 154: 1533-1534

Source: Ramin SM, Gambling DR, Lucas MJ et al: Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995; 86: 783-789

Researchers in Texas conducted a randomized trial to compare the effect on labour outcome of epidural bupivacaine-fentanyl analgesia and intravenous meperidine analgesia in 1330 women with uncomplicated term pregnancies who presented with spontaneous active labour. Women who received the epidural analgesia reported significantly less discomfort throughout labour and were more likely to report satisfaction with pain relief 24 hours after delivery; however, they experienced significantly prolonged labour, were more likely to require oxytocin augmentation of labour and had a higher incidence of operative deliveries and of fever. After parity, race, maternal age, neonatal weight and time from hospital admission to delivery were controlled for, epidural analgesia was still associated with a significantly elevated risk of cesarean section. The authors agree that women should be informed of this increased risk, which may influence their choice of pain relief when labour is well tolerated.

CMAJ May 15, 1996 (vol 154, no 10)