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Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.

ABSTRACT: BACKGROUND:The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%. OBJECTIVES:To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery. STUDY DESIGN:An open label randomized prospective study. METHODS:Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation. Catheters in both groups were initially tested with 3 ml of 1% lidocaine and those with any evidence of motor blockade were considered intrathecal. Sensory blockade and an 11 point numerical rating score for pain were assessed 30 minutes after administration of an epidural bolus of 10 ml of 0.22% ropivacaine with fentanyl. Successful epidural analgesia was defined as a decrease of 2 or more in the pain score and a bilateral L1-T10 sensory blockade. RESULTS:Thirty-one patients were randomized to each group. The first 20 patients in each group were enrolled in a pilot study and were also included in the final analysis. One patient in the electric stimulation group was excluded owing to dural puncture by the Tuohy needle. One patient in each group demonstrated motor blockade after test dose and were considered failures. The number (% (95% confidence interval)) of successful cases were 29 out of 30 (97% (85, 100%)) in the electric stimulation group and 24 out of 31 (77% (61, 89%)) in the loss of resistance group (P = 0.053). However, analysis of only patients with absence of motor blockade revealed that 29 out of 29 (100% (92, 100%)) patients in the electric stimulation group and 24 of 29 (80% (63, 91%)) patients in the loss of resistance group had adequate analgesia (P = 0.024). CONCLUSIONS:Although limited by lack of blinding, small study size and inclusion of pilot study data, this study suggests epidural electric stimulation improves the success rate of subsequent labor analgesia.

SUBMITTER: Lee CH

PROVIDER: S-EPMC6329494 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.

Lee Chung Hun CH Choi Sang Sik SS Lee Mi Kyoung MK Kim Jung Eun JE Chung Dong Ik DI Lee Mido M

PloS one 20190111 1

<h4>Background</h4>The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%.<h4>Objectives</h4>To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery.<h4>Study design</h4>An open label randomized prospective study.<h4>Methods</h4>Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimul ...[more]

PMID: 30633755

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Project description:BackgroundBreastfeeding is essential for infants and mothers. Epidural labor analgesia is used frequently to alleviate pain during vaginal delivery. Studies have found that epidural labor analgesia potentially have negative effects on postpartum breastfeeding. However, the efficacy of epidural labor analgesia on early breastfeeding after vaginal delivery is unclear. Therefore, a retrospective analysis was performed to illuminate the efficacy of epidural labor analgesia on postpartum breast feeding.MethodsA total of 392 women who received vaginal delivery in the Second People's Hospital of Foshan from July 2022 to June 2023 were selected for this study, and all women received epidural labor analgesia and were divided into three groups according to the efficacy of labor analgesia. There were three groups: parturients with VAS scores < 3 were divided into Group E (n = 192), parturients with VAS scores 4-6 were divided into Group M (n = 127), and parturients with VAS scores > 7 were divided into Group P (n = 73). The labor process, lactation initiation time, and incidence of delayed onset of lactation were analyzed. The lactation volume and time and LATCH score at 24, 48 and 72 h after vaginal delivery were also analyzed.ResultsThere was no significant difference in labor process times among the three groups (P > 0.05). The cases of prolactin use in Group M were less than those in Group E and Group P, with a significant difference (all P < 0.05). There was no significant difference in cases of prolactin use between Group E and Group P (P > 0.05). The lactation initiation time in Group M was significantly shorter than those in Group E and Group P (all P>0.05). There was no significant difference in lactation initiation time after vaginal delivery between Group E and Group P (P>0.05). The incidence of delayed onset of lactation in Group M was significantly lower those that in Group E and Group P (all P < 0.05). There was no statistically significant difference in the incidence of delayed onset of lactation between Group E and Group P (P > 0.05). The lactation volumes at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation volume at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). The lactation times at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation times at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). There was no significant difference in LATCH scores at 24, 48 and 72 h after vaginal delivery among the three groups (all P > 0.05).ConclusionsCompared with labor analgesia with excellent and poor analgesia efficacy, labor analgesia with moderate analgesia efficacy has fewer cases of prolactin use, more lactation volume and time, a shorter lactation initiation time, a lower incidence of delayed onset of lactation and no effect on the LATCH score of breastfeeding.

Project description:BackgroundFew studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS).The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS.MethodsIn the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.ResultsWe collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95% CI 1.2-3.3; p=0.005).ConclusionsOur findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.

Dataset Information

Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.

Publications

Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.

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