Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women

被引:137
作者
Nageotte, MP
Larson, D
Rumney, PJ
Sidhu, M
Hollenbach, K
机构
[1] WOMENS HOSP MED CTR,LONG BEACH MEM MED CTR,LONG BEACH,CA
[2] UNIV CALIF SAN DIEGO,DEPT FAMILY PREVENT MED,SAN DIEGO,CA 92103
关键词
D O I
10.1056/NEJM199712113372402
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Among nulliparous women, there appears to be an association between the use of epidural analgesia during labor and an increased risk of dystocia. We tested the hypothesis that combined spinal-epidural analgesia, which permits ambulation during labor, is associated with a lower incidence of dystocia than continuous lumbar epidural analgesia. Methods Between July 1995 and September 1996, we randomly assigned 761 nulliparous women in spontaneous labor at term who requested epidural analgesia to receive either continuous lumbar epidural analgesia or a combination of spinal and epidural analgesia. Among the women who received combined spinal-epidural analgesia, some were discouraged from walking and others were encouraged to walk. Maternal and neonatal outcomes, the incidence of dystocia necessitating cesarean section, and measures of patients' satisfaction were compared in the two groups. Results There were no significant differences in the overall rate of cesarean section, the incidence of dystocia, the frequency of maternal or fetal complications, the patients' or nursing staff's assessment of the adequacy of analgesia, or the degree of overall satisfaction between the two groups. Significantly more women receiving combined spinal-epidural analgesia had pruritus (P<0.001) and requested additional epidural bolus doses of local anesthetic (P=0.01). For all the women, dystocia necessitating cesarean section was significantly more likely when analgesia was administered with the fetal vertex at a negative station (odds ratio, 2.5; P<0.001) or at less than 4 cm of cervical dilatation (odds ratio, 2.2; P<0.001). Conclusions As compared with continuous lumbar epidural analgesia, the combination of spinal and epidural analgesia is not associated with an overall decrease in the incidence of cesarean delivery. (C) 1997, Massachusetts Medical Society.
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页码:1715 / 1719
页数:5
相关论文
共 33 条
[1]  
BREEN TW, 1993, ANESTH ANALG, V77, P919
[2]   SUPPORTIVE NURSE-MIDWIFE CARE IS ASSOCIATED WITH A REDUCED INCIDENCE OF CESAREAN-SECTION [J].
BUTLER, J ;
ABRAMS, B ;
PARKER, J ;
ROBERTS, JM ;
LAROS, RK .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1993, 168 (05) :1407-1413
[3]   A COMPARISON OF INTRATHECAL, EPIDURAL, AND INTRAVENOUS SUFENTANIL FOR LABOR ANALGESIA [J].
CAMANN, WR ;
DENNEY, RA ;
HOLBY, ED ;
DATTA, S .
ANESTHESIOLOGY, 1992, 77 (05) :884-887
[4]   DOES EARLY ADMINISTRATION OF EPIDURAL ANALGESIA AFFECT OBSTETRIC OUTCOME IN NULLIPAROUS WOMEN WHO ARE IN SPONTANEOUS LABOR [J].
CHESTNUT, DH ;
MCGRATH, JM ;
VINCENT, RD ;
PENNING, DH ;
CHOI, WW ;
BATES, JN ;
MCFARLANE, C .
ANESTHESIOLOGY, 1994, 80 (06) :1201-1208
[5]   DOES EARLY ADMINISTRATION OF EPIDURAL ANALGESIA AFFECT OBSTETRIC OUTCOME IN NULLIPAROUS WOMEN WHO ARE RECEIVING INTRAVENOUS OXYTOCIN [J].
CHESTNUT, DH ;
VINCENT, RD ;
MCGRATH, JM ;
CHOI, WW ;
BATES, JN .
ANESTHESIOLOGY, 1994, 80 (06) :1193-1200
[6]  
Collis R E, 1994, Int J Obstet Anesth, V3, P75, DOI 10.1016/0959-289X(94)90173-2
[7]   RANDOMIZED COMPARISON OF COMBINED SPINAL-EPIDURAL AND STANDARD EPIDURAL ANALGESIA IN LABOR [J].
COLLIS, RE ;
DAVIES, DWL ;
AVELING, W .
LANCET, 1995, 345 (8962) :1413-1416
[8]  
DIRO M, 1985, J NATL MED ASSOC, V78, P569
[9]  
FRIGOLETTO FD, 1995, NEW ENGL J MED, V333, P1163
[10]   A CLINICAL-TRIAL OF ACTIVE MANAGEMENT OF LABOR [J].
FRIGOLETTO, FD ;
LIEBERIAN, E ;
LANG, JM ;
COHEN, A ;
BARSS, V ;
RINGER, S ;
DATTA, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (12) :745-750