Title: Reducing likelihood of instrumental delivery with epidural anaesthesia
Abstract: Intermittent boluses of local anaesthetic in the epidural space provide such effective analgesia for labour that randomised trials evaluating side-effects have been difficult. How do you persuade a woman in labour to enter a study that may randomly allocate her to a (seemingly) less effective method of pain relief? Nevertheless, to many peoples' surprise, 1 Reynolds F Dewan D Morgan B Ethics and clinical research in obstetric anaesthesia. Lancet. 1992; 339: 1234-1235 Abstract PubMed Scopus (10) Google Scholar this can be done. The solution is to compare a liberal policy with one that avoids an epidural as far as possible. This approach is ethical, and if analysis is by original allocation—ie, by “intention to treat”—there is an unbiased assessment of the effect of the two policies. There have been at least 12 such trials involving 3526 patients, most nulliparous. 2 Howell CJ Epidural versus non-epidural analgesia for pain relief in labour (Cochrane review). The Cochrane Library, Issue 1. Update Software, Oxford2001 Google Scholar , 3 Howell CJ Kidd W Roberts W et al. A randomised controlled trial of epidural compared with non-epidural analgesia in labour. Br J Obstet Gynaecol. 2001; 108: 27-33 Scopus (0) Google Scholar Traditional epidural analgesia does not increase the proportion of women needing a caesarean section for delivery, the frequency of adverse fetal outcomes, or long-term back pain, but it is associated with a substantial increase in assisted vaginal deliveries. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trialThe use of low-dose epidural techniques for labour analgesia has benefits for delivery outcome. Continued routine use of traditional epidurals might not be justified. Full-Text PDF
Publication Year: 2001
Publication Date: 2001-07-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 38
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