Need for additional anesthesia after single injection spinal analgesia for labor: a retrospective cohort study

Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study

BACKGROUND

The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter.

METHODS

In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias.

RESULTS

The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005].

CONCLUSIONS

LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.

Effectiveness of Spinal Analgesia for Labor Pain Compared with Epidural Analgesia

Objectives

This study aimed to compare the analgesic effect of single-dose spinal versus epidural analgesia for labor pain to verify if applying a single dose spinal analgesia is an efficient technique for labor pain management as an alternative for epidural analgesia.

Methods

A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal analgesia (n = 64) and epidural analgesia (n = 64). The latter received a bolus dose of 16 mL of 0.125% bupivacaine and 50 μg fentanyl and repeated 5 - 10 mL of bolus dose. The former received 2.5 mg hyperbaric bupivacaine plus 50μg fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of analgesia, mode of delivery, the duration of labor, side effects, and maternal satisfaction were also compared.

Results

There were no significant differences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after analgesia between the two groups. Measured pain after 30 (P = 0.0001) and 90 min (P = 0.01) was significantly lower in the spinal group than the epidural group. However, there was no significant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0.002). The mean duration of analgesia was longer in the spinal group than the epidural group (P = 0.0001).

Conclusions

According to the findings, single-dose spinal analgesia, compared to epidural analgesia, is a safe, fast, and efficient technique for labor analgesia, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.

Reviewing pain management options for patients in active labor

Pain perception and preferences for pain management are unique to each woman in labor. This article provides an overview of the physiology of labor pain, discusses available nonpharmacologic and pharmacologic approaches to managing pain during active labor, and discusses potential benefits and risks for each option.