Clincal Evidence of Analgesia During Labor_Chinese Journal of Evidence-Based Medicine

Authors：

 LIN Xuemei , ZHOU Jun , TANG Yuying , MA Yushan

Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu 610041 , China;

Corresponding author：

LIN Xuemei, Email: lxm0301@sina.com

Keywords：

Labour analgesia; Evidence-based therapy; systematic reviews; meta-analyses; Cochrane reviews

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Objective 　To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour.
Methods 　We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia.
Results 　We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section.
Conclusion 　Epidural analgesia is superior to other approaches.

Citation： LIN Xuemei,ZHOU Jun,TANG Yuying,MA Yushan. Clincal Evidence of Analgesia During Labor. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 843-846. doi: Copy

1.	李幼平. 主编. 循证医学. 第1版. 北京: 高等教育出版社; 2003. 20~21.
2.	Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
3.	Hughes D, Simmons SW, Brown J. Combined spinal-epidural versus epidural analgesia in labour Cochrane Database of Systematic Reviews 2006, Issue 4.
4.	Hedayati H, Parsons J, Crowthe CA. Rectal analgesia for pain from perineal trauma following childbirth The Cochrane Database of Systematic Reviews 2006, Issue 4.
5.	Smith CA , CollinCT s, Cyna AM, et al. Complementary and alternative therapies for pain management in labour The Cochrane Database of Systematic Reviews 2006, Issue 4.
6.	Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth.The Cochrane Database of Systematic Reviews 2006, Issue 4.
7.	Hodnett ED, Downe S, Dwards N, et al. Home-like versus conventional institutional settings for birth Cochrane Database of Systematic Reviews 2006, Issue 4.
8.	Elbourne D, Wiseman RA. Types of intra-muscular opioids for maternal pain relief in labour. The Cochrane Database of Systematic Reviews 2006, Issue 4.
9.	Torvaldsen S, Roberts CL, Bell JC, et al. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia The Cochrane Database of Systematic Reviews 2006, Issue 4.
10.	Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004;328(7453): 1410.
11.	Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004; 100(1): 142–148.
12.	Writer WD, Stienstra R, Eddleston JM, et al. Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. Br J Anaesth, 1998; 81: 713–717.
13.	Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg, 2003; 96(5): 1473–1479.
14.	Bucklin BA, Chestnut DH, Hawkins JL. Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis. Reg Anesth Pain Med, 2002; 27(1): 23–30.
15.	Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG, 2002; 109(12): 1344–1353.
16.	Li YP. Editor-in-Chief. Evidence-Based Medicine. 1st Edition. Beijing: Higher Education Press; 2003. 20–21.

1. 李幼平. 主编. 循证医学. 第1版. 北京: 高等教育出版社; 2003. 20~21.
2. Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
3. Hughes D, Simmons SW, Brown J. Combined spinal-epidural versus epidural analgesia in labour Cochrane Database of Systematic Reviews 2006, Issue 4.
4. Hedayati H, Parsons J, Crowthe CA. Rectal analgesia for pain from perineal trauma following childbirth The Cochrane Database of Systematic Reviews 2006, Issue 4.
5. Smith CA , CollinCT s, Cyna AM, et al. Complementary and alternative therapies for pain management in labour The Cochrane Database of Systematic Reviews 2006, Issue 4.
6. Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth.The Cochrane Database of Systematic Reviews 2006, Issue 4.
7. Hodnett ED, Downe S, Dwards N, et al. Home-like versus conventional institutional settings for birth Cochrane Database of Systematic Reviews 2006, Issue 4.
8. Elbourne D, Wiseman RA. Types of intra-muscular opioids for maternal pain relief in labour. The Cochrane Database of Systematic Reviews 2006, Issue 4.
9. Torvaldsen S, Roberts CL, Bell JC, et al. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia The Cochrane Database of Systematic Reviews 2006, Issue 4.
10. Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004;328(7453): 1410.
11. Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004; 100(1): 142–148.
12. Writer WD, Stienstra R, Eddleston JM, et al. Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. Br J Anaesth, 1998; 81: 713–717.
13. Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg, 2003; 96(5): 1473–1479.
14. Bucklin BA, Chestnut DH, Hawkins JL. Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis. Reg Anesth Pain Med, 2002; 27(1): 23–30.
15. Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG, 2002; 109(12): 1344–1353.
16. Li YP. Editor-in-Chief. Evidence-Based Medicine. 1st Edition. Beijing: Higher Education Press; 2003. 20–21.

Chinese Journal of Evidence-Based Medicine

Clincal Evidence of Analgesia During Labor

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