Timing of administration of epidural analgesia and risk of operative delivery in nulliparous women: A case–control randomised study

Abstract

>Background and Aim: Epidural analgesia (EA) offers an effective form of labour analgesia. The time of administration of EA and its relationship with the mode of delivery is controversial. Our study tried to assess whether early initiation of epidural analgesia influences the obstetric outcome in nulliparous women.Materials and Methods: This was a case control, randomised study which included 60 parturients in spontaneous labour divided into two equal groups, the cases and controls. Cases received EA with 10 mL of 0.125% injection bupivacaine, whereas the control group received a systemic opioid (injection pethidine 100 mg intramuscularly) for pain relief. Cases were further divided into parturients receiving EA at a cervical dilatation of 3 cm or less classified as the early epidural group and those receiving EA at 4 cm or more classified as the late epidural group. The modes of delivery for the study population were recorded. Data analysis was done using Wilcoxon two-sample test. P < 0.05 was considered statistically significant.Results: The rate of instrumental vaginal delivery between the early epidural group [95% confidence interval (CI) 0.358–10.821; P = 0.43] and late epidural group (95% CI 0.150–6.055; P = 0.96) was not significantly different. The cesarean-delivery rate was also not significantly different between those receiving early EA (P = 0.95) and late EA (P = 0.58) when compared with control group.Conclusion: This study showed no significant difference in the incidence of caesarean or instrumental delivery for women receiving early epidural analgesia when compared with late epidurals or no EA.

Keywords

• Analgesia
• delivery
• epidural
• obstetrical
• obstetric analgesia