Statistics on Epidural Analgesia Made on Admitted Patients for Normal Vaginal Delivery, Outcome Results and Benefits

Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient. Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery. Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were approached for the consenting process, and those who agreed to participate in the study were included in the analysis. Patients were stratified in two groups based on the type of pain control they opted for/received at the time of admission: epidural delivered anesthesia or intravenous infusion of pain medications. Results: A 100 eligible women consented to take part in the study, between January 1st, 2020 and December 31st, 2020. Maternal and fetal survival at the 30-days mark was 100.0% for both groups. Duration of labor was significantly 0.1h shorter in the epidural group with a mean of 6.7 ± 1.8 h as opposed to 6.8 ± 2.6 h in the nonepidural group. Use of forceps and/or vacuum was significantly higher in the epidural group 9 (17.3%) and 2 (3.8%) as opposed to 1 (2.1%) and 0 (0.0%) in the epidural group. A higher rate of severe perineal tears (grade 3 or more) was observed in women who received epidural anesthesia. Conclusion: Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU. Epidural anesthesia however remains a risk factor for AVD and thus the use of instruments Its role as for severe perineal lacerations remains unclear according to our data, as we did not account for confounding factors. This last point remains to be investigated in large population-based studies.

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.

Effect of epidural labor analgesia on postpartum depression and maternal and infant outcomes in parturients with gestational diabetes mellitus---A prospective cohort study

BackgroundPostpartum depression (PPD) negatively affects the health of new mothers and can impair infant development. Both labor pain and gestational diabetes mellitus (GDM) are potential risk factors for PPD. However, the effects of epidural labor analgesia in parturients with GDM on PPD and maternal and infant outcomes have not been characterized.MethodsParturients with GDM in our hospital were assigned to the epidural group (n = 133) and no epidural (control) group (n = 130) according to their choice to receive epidural labor analgesia. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate maternal mental status at 24 h and 42 days postpartum. Data for relative variables in the perinatal period were collected, and the potential associations of epidural analgesia with PPD and maternal and infant outcomes were analyzed by univariate analysis and multivariate logistic regression analyses.ResultsEpidural analgesia was a protective factor for PPD at 24 h postpartum (odds ratio [OR], 0.301, 95% confidence interval [CI]: 0.104–0.867, p < 0.05), and the EPDS score at 24 h post-delivery showed significant correlation with that at 42 days post-delivery (Pearson correlation coefficient = 0.527, p < 0.001). The rate of neonatal admission to the neonatal intensive care unit (NICU) for hypoglycemia was higher in the epidural group (6.92%) than in the control group (1.50%; p < 0.05). Epidural analgesia and drug-based diabetes control were independent predictors of the rate of neonate transfer to the NICU for hypoglycemia.ConclusionEpidural analgesia was a protective factor for PPD at 24 h postpartum, but associated with an increased risk of neonatal transfer to the NICU for hypoglycemia. Thus, monitoring of neonatal blood glucose levels after administration of epidural analgesia in parturients with GDM may be beneficial.Clinical Trial Registrationthe study was registered in the China Clinical Registration Center (URL: http://www.chictr.org.cn/listbycreater.aspx, Registration No. ChiCTR-OOC-17013164)

The Effects of Epidural Analgesia during Labor on Maternal and Neonatal Outcomes

Background: The purpose of the study was to investigate the impact of epidural analgesia usage vs. non-epidural labor on maternal and neonatal outcomes. Methods: We included 129 parturients who had vaginal deliveries in our hospital since December 1, 2018. The women were grouped into the epidural analgesia group or the non-epidural group. In order to investigate the effect of epidural analgesia on mother and newborn outcomes, we evaluated the differences in labor duration, the Apgar score of the newborn, and the overall outcome of the mother and newborn. Results: Compared to the non-epidural group, the durations of the first and second stages of labor in the analgesia group were significantly longer. In terms of neonatal outcome, the epidural analgesia group had a higher lactate value in the umbilical artery blood and higher pCO2 of umbilical vein blood of the neonates. However, there were no significant differences in Apgar Score, umbilical blood pH, base excess, or other umbilical cord blood gas analyses (pO2, HGB, SO2, HCO3 -) between epidural analgesia and non-epidural labor groups.Conclusion: The epidural analgesia prolongs the duration of the first and second stages of labor and affects the level of lactate in umbilical artery blood and the partial pressure of carbon dioxide in umbilical vein blood. There was no significant effect on the basic characteristics of the mothers and neonates, suggesting that epidural analgesia delivery technology is safe, but it may have a particular short-term impact on neonatal outcomes.

Inflammatory and oxidative alterations of water immersion and epidural analgesia during the labor

Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia. Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p>0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p<0.001). Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.

Comparison of the effectiveness between epidural methylprednisolone injection and intranasal calcitonin in reduction of back pain due to osteoporosis in postmenopausal patients: a randomized controlled trial

<p class="abstract"><strong>Background:</strong> Back pain is a common symptom in osteoporotic patients due to spinal compression fracture. Conservative management like nonsteroidal anti-inflammatory drugs and spinal orthoses has not been able to produce early pain relief. Intranasal calcitonin spray is considered effective because of its analgesic effect and increase in bone density. Role of epidural steroid injection for the treatment of osteoporotic back pain has not been studied. This study was conducted to find out the efficacy of epidural methylprednisolone injection in management of osteoporotic back pain in postmenopausal patients.</p><p class="abstract"><strong>Methods:</strong> Hundred patients with osteoporotic back pain in postmenopausal subjects were allocated into two groups: epidural and calcitonin. Epidural group received a single dose of interlaminar epidural steroid injection with methylprednisolone 80 mg. Calcitonin group received one puff of 200 IU given through one nostril followed to the other nostril the next day. Visual analogue scale for pain was the outcome measurement used. Pain relief at rest within 7 days was taken as early pain relief and within 21days as late pain relief. Pain relief after 21^st day was considered no response. Test of significance was done by Kaplan Meier, Chi square and Fisher exact tests.</p><p class="abstract"><strong>Results:</strong> Out of 50 patients, 38 patients in the epidural group got pain relief within 7 days and the finding was statistically significant.</p><p class="abstract"><strong>Conclusions: </strong>Epidural methylprednisolone gives faster pain relief as early as the first post-injection day with a median value of 2 days against 15 days in case of intranasal calcitonin spray.</p>

Combined spinal epidural anaesthesia versus epidural anaesthesia: a comparative study

Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Com­bined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epi­dural anaesthesia. Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly di­vided into 2 groups. Group A patients received CSEA using “double needle double interspace tech­nique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subse­quent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Chi-square test where appropriate and the Statistical Analysis was done using SPSS program, version 11.0. Results: The surgical anaesthesia and motor blockade occurred significantly early in CSEA group. Duration of analgesia was significantly shorter in CSEA (84.1±40.6 min) as compared to epidural group (138.6±32.9 min). The total amount of bupivacaine required to attain the same target level was two times in epidural group (p<0.05). Haemodynamic changes were comparable in both the groups. No neurological side effects were observed. Conclusions: Sequential CSEA is superior alternative to epidural block, which combines the advan­tages of spinal and epidural while minimizing their drawbacks in elective gynaecological surgeries.

A Comparative Study of Effectiveness of Ultrasound-Guided Transversus Abdominis Plane (TAP) Block vs Epidural Analgesia for Post-Operative Pain Relief in Lower Abdominal Surgeries

Background: An increase in the use of regional anesthesia techniques for postoperative pain relief for analgesia following lower abdominal surgeries. Epidural anesthesia considered as the "gold standard" has been established to provide excellent analgesia as well as attenuation of neurogenic contribution to inflammation. The TAP block provides reliable somatic analgesia in lower abdominal incision surgeries. Use of ultrasound helps incorrect localization of the plane and accurate placement of the needle and catheter.Subjects and Methods:In TAP group under USG guidance 20 ml 0.2% Inj. Ropivacaine was deposited on each side of the abdominal wall. In Epidural group 10 ml of 0.2% Inj. Ropivacaine was administered at skin closure.Results:Systolic and diastolic blood pressure levels were significantly lower in group B as compared to group A (p<0.05). . VAS score was significantly higher in group B as compared to group A (P<0.05). It was observed that a significantly higher number of patients in epidural group required rescue analgesia and at higher dosages (p<0.05).Conclusion:TAP block has almost no complications, keeps the patient hemodynamically stable and offers a good early postoperative analgesia (till 24 hours) when compared to a more accepted modality like epidural analgesia.

Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program

ObjectiveThe aim of this study was to identify the rate of 30-day postoperative complications after the use of epidural in women undergoing hysterectomy for gynecologic malignancy. Secondary outcome was the impact of epidural on hospital length of stay.MethodsA retrospective cohort study was conducted using the American College of Surgeons’ National Surgical Quality Improvement Program database. This large dataset includes perioperative risk factors and 30-day post-operative outcomes from more than 680 hospitals. Women who underwent abdominal hysterectomy for a gynecologic malignancy from January 2014 to December 2017 were included. Adult patients (18 years or older) who underwent abdominal hysterectomy were identified using common procedure terminology and international classification of diseases codes. Only laparotomy cases were included, and minimally invasive cases (laparoscopy, transvaginal) were excluded due to the small prevalence of epidural cases in this cohort. All patients received general anesthesia. If patients were noted to have “epidural anesthesia” they were included in the epidural cohort and those receiving other adjuvant techniques (regional blocks or spinal anesthesia) were excluded. The primary outcome of interest was the 30-day occurrence of a pulmonary embolism, deep-vein thrombosis, pneumonia, and urinary tract infection. Those who received epidural analgesia were matched in a 1:1 ratio with a similar group of patients who did not receive epidural analgesia using a calculated propensity score to control for confounding factors.ResultsA total of 2035 (13.8%) patients undergoing abdominal hysterectomy for a gynecologic malignancy received epidural analgesia. 1:1 propensity-matched samples included 2035 patients in both epidural and no-epidural groups. Patient characteristics between groups were similar. Overall 30-day complication rates were higher in the epidural group (75.9% vs 62.0%, P<0.01). Specific complications that were higher in the epidural group included: blood transfusion (28.9% vs 22.8%); wound disruption (2.0% vs 1.1%); surgical site infection (10.1% vs 7.2%); and delay in return of bowel function (12.3% vs 9.3%) (all P<0.05). Hospital length of stay was significantly longer in the epidural group as compared with the no-epidural group (5.69 days vs 4.79 days, P<0.01) and readmissions were higher in the epidural group (10.5% vs 9.7%, P<0.01), but there was no difference in 30-day mortality between the groups (P=0.62).DiscussionThe rate of 30-day complications and length of stay among women undergoing an abdominal hysterectomy for gynecologic malignancy was higher for those who received epidural analgesia, but there was no difference in 30-day mortality. Although epidural analgesia can provide a number of benefits when used for postoperative pain control, the possible association with increased 30-day morbidity and length of stay needs to be considered.

Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring

BackgroundThere are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique.MethodsA prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor.ResultsTen cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased.ConclusionIn VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.