Epidural versus low-dose spinal for analgesia of late first stage of labor: a randomized clinical trial

Abstract

Background & Objectives: Epidural analgesia is the most effective method of reducing pain during normal delivery. However, it may not be a suitable choice in parturients presented in the late first stage of labor due to lack of time and lack of cooperation by the parturients. Spinal analgesia could be a suitable alternative. We compared epidural with spinal anesthesia for pain relief during late first stage of labor.

Methodology: 100 parturient, who presented in the late first stage of labor and requested neuraxial analgesia, were randomized to receive either epidural analgesia or single-shot spinal analgesia. The time needed to perform the block, onset and duration of analgesia, sensory level, hemodynamic effects, maternal side effects, and neonatal outcomes were recorded in both groups.

Results: The time needed to perform the block was significantly shorter in the spinal group (5.2 ± 0.9 min) than in the epidural group (17.3 ± 1.5 min) (P < 0.001). The onset of analgesia and time to reach adequate analgesia were significantly faster in the spinal group (P < 0.001). Pain scores decreased significantly in the spinal group until 15 min after the block. After that point, there were no significant differences in both groups. Regarding MAP, there was no significant difference except at 5 min after the block in the spinal group, with a significant reduction in MAP (P < 0.001). There were no significant changes between the two groups as regards maternal side effects and neonatal outcomes.

Conclusion: Although epidural analgesia is the most reliable method for pain control in normal labor. however, spinal analgesia may be a good alternative, especially in parturients presenting in late first stage of labor.

Abbreviations: GA- General Anesthesia; MAP - Mean Arterial Pressure; HR- Heart Rate

Key words: Neuraxial analgesia; Spinal; Epidural Analgesia; Normal labor

Citation: Alansary AM, Ali MM, Elbeialy MAK. Epidural versus low-dose spinal for analgesia of late first stage of labor: a randomized clinical trial. Anaesth. pain intensive care 2023;27(2):227−235; DOI: 10.35975/apic.v27i2.2193

Received: December 24, 2022; Reviewed: January 18, 2023; Accepted: February 08, 2023