Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial.

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.

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Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-035887 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035887

Author(s):

Jialing Xu ◽

Riyong Zhou ◽

Weijue Su ◽

Shi Wang ◽

Yun Xia ◽

...

Keyword(s):

Lower Limb ◽

Outcome Measure ◽

Controlled Trial ◽

Control Group ◽

Bolus Administration ◽

Ultrasound Guided ◽

Double Blind ◽

Second Stage ◽

Second Stage Of Labour ◽

Nulliparous Women

ObjectiveTo explore whether an ultrasound-guided pudendal nerve block (PNB) could decrease anaesthetic use, thereby shortening the length of the second stage of labour in women undergoing epidural analgesia.DesignProspective, single-centre, randomised, double-blind, controlled trial.SettingAn obstetric centre in a general hospital in China.Participants72 nulliparous women were randomised, and 71 women completed the study.InterventionAn ultrasound-guided bilateral PNB was administered to all study participants; the PNB group were given 0.25% ropivacaine 10 mL, while the control group were given 10 mL saline.Main outcome measureThe primary outcome measure was the duration of the second stage of labour. Secondary outcomes included additional bolus administration, total hourly bupivacaine consumption, difference in thickness between the contracted and relaxed rectus abdominis muscle before (DRAM1) and 30 min after (DRAM2) PNB, urge to defecate, maternal cooperation, preservation of the lower limb motor function, tightness of the perineum, and Numeric Rating Scale (NRS) score for pain.ResultsThe duration of the second stage of labour was shorter in the PNB group than in the control group (difference of 33.8 min (95% CI 15.6 to 52.0), p<0.001). Additional bolus administration and total hourly bupivacaine consumption were lower in the PNB group than in the control group (p<0.001). DRAM2 was greater (p<0.001), rate of parturient women with the urge to defecate was higher (p=0.014), maternal cooperation was superior (p=0.002), and lower limb motor function preservation was greater (p=0.004) in the PNB group relative to the control group. Tightness of the perineum was eliminated from the results due to the inconsistent application of the criteria by the nursing staff. There was no significant difference in NRS scores between the groups.ConclusionsNulliparous women with epidural analgesia who received an ultrasound-guided bilateral PNB may reduce their need for bupivacaine and consequently shorten the length of the second stage of labour, therein indicating that a bilateral PNB may serve as an additional effective adjunct method of labour analgesia.Trial registration numberChiCTR-IOR-16009121.

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