BACKGROUND AND PURPOSE:

• Modern use of low concentration epidural anesthesia generally does not induce motor block or necessarily impair pushing or walking
• Shen et al. (Obstet Gynecol, 2017) evaluated the impact of continuing epidural infusion during the 2^nd stage of labor

METHODS:

• Prospective, double blind, randomized, placebo-controlled trial
• Inclusion criteria
  • Healthy nulliparous women ≥ 37 weeks
  • Presented in spontaneous labor and requested an epidural
  • Cephalic singleton pregnancies
• Patients were at < 6cm dilation at time of epidural request and did not receive oral or IV analgesia
• All patients received epidural analgesia for the 1st stage of labor using
  • initial bolus 8–10 mL of 0.08% ropivacaine with sufentanil (0.4 micrograms/mL)
  • with patient-controlled epidural infusion of the same solution at 8mL/h
• At full cervical dilation, women were randomized in to two arms
  • Blinded infusion of same ropivacain / sufentanil solution
  • Blinded infusion of placebo
• The primary outcome was the duration of the second stage of labor
• Secondary outcomes included
  • Patient perceived pain scores and satisfaction (on a scale of 11)
  • Maternal and fetal outcomes such as mode of delivery, use of episiotomy, fetal position at delivery, neonatal Apgar scores and cord gasses

RESULTS:

• 400 patients were randomized
• Using an intention- to- treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52)
• The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17)
• Pain scores were similar between groups
• More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001)
• There was no statistical difference in maternal and neonatal outcomes

CONCLUSION:

• Maintaining the infusion of epidural medication into the second stage of labor does not impact length of the 2^nd  stage of labor

Learn More – Primary Sources:

Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.

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