Neuraxial analgesia early in labor is good option.(Obstetrics)

Nulliparous women who request pain relief early in labor may be better off receiving neuraxial analgesia than systemic opioid analgesia, according to investigators of a recently published, randomized trial.

Of 728 women who had spontaneous labor or spontaneous rupture of membranes, those who received intrathecal fentanyl when cervical dilation was less than 4 cm did not face an increased risk of having a cesarean section and had a shorter duration of labor, compared with those who received systemic hydromorphone early in labor.

Women who received neuraxial analgesia also reported better pain control, according to Cynthia A Wong, M.D., and her colleagues at Northwestern University in Chicago.

The findings show women who request pain relief early in spontaneous labor "can receive neuraxial analgesia at that time without adverse consequences," the researchers said.

Women who request analgesia early in labor frequently receive systemic opioid analgesia, in keeping with the American College of Obstetricians and Gynecologists recommendation that epidural anesthesia be delayed, when feasible, until cervical dilation is at least 4-5 cm; other forms of analgesia should be used until that time.

Systemic opioid analgesia is often incomplete, however, and has potential maternal and fetal side effects, including neonatal and maternal respiratory depression (N. Engl. J. Med. 2005;352:655-65).

Laura Goetzl, M.D., who helped write ACOG's 2002 Practice Bulletin on Obstetric Analgesia and Anesthesia, said in an interview that the new findings present "another option" for prolonging the time to epidural.