Spinal Administration Beats Infusion Method.

TORONTO -- Neonatal outcomes may be improved when low-dose epidurals are administered spinally instead of by infusion, according to a new analysis of data from the Comparative Obstetric Mobile Epidural Trial.

"If you're worried about the outcome of the baby, the spinal administration with top-ups may be better than the infusion without compromising pain control," said Dr. Andrew Shennan, a senior lecturer in maternal-fetal medicine and obstetrics at Guy's, King's College, and St. Thomas's Hospitals' School of Medicine in London.

Previous results from COMET have shown that both forms of low-dose epidurals--also known as mobile or walking epidurals--result in fewer forceps and vacuum deliveries, compared with the traditional higher-dose epidurals, he said at the annual meeting of the Society for Gynecologic Investigation.

The new analysis provides further distinction between the different low-dose techniques.

"Fentanyl is an opiate and is known to cross to the baby. In our study, this meant that Apgar scores were more likely to below in the infusion group, and there were more babies who needed resuscitation," he told this newspaper.

"Because the infusion method provides a constant delivery of drug, there is significantly more fentanyl given with this method, as compared with the spinal method, which is simply followed by top ups as needed," Dr. Shennan said.

The study included 1,054 primiparous women from two British centers who were randomized into one of three arms.