Re: OB: NEJM Article On Analgesia
From: Charlie Chambers (cchamber@gorge.net)
Thu Feb 17 15:48:59 2005
In my humble opinion, I've always believed that epidurals are like
I.V.'s, it's a conduit. The real effect is what you elect to put
through them.
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Charlie Chambers
Hood River, OR USA
cchamber@alumni.rice.edu
"...not because I regard fishing as being so terribly
important but because I suspect that so many of the other
concerns of men are equally unimportant-and not nearly
so much fun."
John Voelker
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On Feb 17, 2005, at 12:22 PM, art fougner, md wrote:
> In today's NEJM ...
>
> The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early
> versus Late in Labor
> Cynthia A. Wong, M.D., Barbara M. Scavone, M.D., Alan M. Peaceman,
> M.D., Robert J. McCarthy, Pharm.D., John T. Sullivan, M.D., Nathaniel
> T. Diaz, M.D., Edward Yaghmour, M.D., R-Jay L. Marcus, M.D., Saadia
> S.
> Sherwani, M.D., Michelle T. Sproviero, M.D., Meltem Yilmaz, M.D.,
> Roshani Patel, R.N., Carmen Robles, R.N., and Sharon Grouper, B.S.
>
> ABSTRACT
>
> Background Epidural analgesia initiated early in labor (when the cervix
> is less than 4.0 cm dilated) has been associated with an increased risk
> of cesarean delivery. It is unclear, however, whether this increase in
> risk is due to the analgesia or is attributable to other factors.
>
> Methods We conducted a randomized trial of 750 nulliparous women at
> term
> who were in spontaneous labor or had spontaneous rupture of the
> membranes and who had a cervical dilatation of less than 4.0 cm. Women
> were randomly assigned to receive intrathecal fentanyl or systemic
> hydromorphone at the first request for analgesia. Epidural analgesia
> was initiated in the intrathecal group at the second request for
> analgesia and in the systemic group at a cervical dilatation of 4.0 cm
> or greater or at the third request for analgesia. The primary outcome
> was the rate of cesarean delivery.
>
> Results The rate of cesarean delivery was not significantly different
> between the groups (17.8 percent after intrathecal analgesia vs. 20.7
> percent after systemic analgesia; 95 percent confidence interval for
> the
> difference, –9.0 to 3.0 percentage points; P=0.31). The median time
> from the initiation of analgesia to complete dilatation was
> significantly shorter after intrathecal analgesia than after systemic
> analgesia (295 minutes vs. 385 minutes, P<0.001), as was the time to
> vaginal delivery (398 minutes vs. 479 minutes, P<0.001). Pain scores
> after the first intervention were significantly lower after intrathecal
> analgesia than after systemic analgesia (2 vs. 6 on a 0-to-10 scale,
> P<0.001). The incidence of one-minute Apgar scores below 7 was
> significantly higher after systemic analgesia (24.0 percent vs. 16.7
> percent, P=0.01).
>
> Conclusions Neuraxial analgesia in early labor did not increase the
> rate
> of cesarean delivery, and it provided better analgesia and resulted in
> a
> shorter duration of labor than systemic analgesia.
>
> http://content.nejm.org/cgi/content/abstract/352/7/655
>
> The controversy continues ...
>
> art
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere
> else."
> Lawrence Peter Berra
>
