Early neuraxial analgesia proves superior for pain relief, shorter labor than opioids.(Obstetrics)

FORT MYERS, FLA. -- Early neuraxial analgesia provided better pain relief, was associated with a shorter labor, and did not increase the cesarean delivery rate when compared with systemic opioid analgesia in a large, randomized trial.

The findings call into question those of previous studies showing an increased operative delivery rate with early neuraxial analgesia and suggest neuraxial analgesia need not be withheld until cervical dilation of 4-5 cm is achieved, Dr. Cynthia A. Wong commented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The study enrolled 728 healthy, nulliparous women with singleton pregnancies at term, with vertex presentation and cervical dilation of less than 4 cm. The women presented in spontaneous labor, requested analgesia, and were randomized to receive either intrathecal fentanyl as part of a combined spinal-epidural technique or systemic hydromorphone, said Dr. Wong of Northwestern University, Chicago.

In the patients in the intrathecal fentanyl group, who had a median cervical dilation of 2 cm at initiation of neuraxial analgesia, epidural analgesia followed by patient-controlled epidural analgesia was initiated at the second request for analgesia. In the systemic analgesia group, epidural analgesia followed by patient-controlled epidural analgesia was initiated at a dilation of at least 4 cm or at the third request (median dilation of 4 cm).

An observation group consisted of 135 patients who first requested analgesia at a dilation of at least 4 cm (median dilation of 4 cm); those patients ...