Long-term Effects of Epidural Analgesia in Labor: A Randomized Controlled Trial Comparing High Dose with Two Mobile Techniques

Authors

  • Matthew J. A. Wilson MD, FRCA,

    1. Matthew J. A. Wilson is a Consultant Anaesthetist in the Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Phillip A. S. Moore is a Consultant Anaesthetist in the Department of Anaesthesia, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham; Andrew Shennan is Professor of Obstetrics at the Maternal and Fetal Research Unit, King’s College, University of London, London; Robert J. Lancashire is a Data Scientist at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham; and Christine MacArthur is Professor of Maternal and Child Epidemiology at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
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  • Phillip A. S. Moore MD, FRCA,

    1. Matthew J. A. Wilson is a Consultant Anaesthetist in the Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Phillip A. S. Moore is a Consultant Anaesthetist in the Department of Anaesthesia, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham; Andrew Shennan is Professor of Obstetrics at the Maternal and Fetal Research Unit, King’s College, University of London, London; Robert J. Lancashire is a Data Scientist at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham; and Christine MacArthur is Professor of Maternal and Child Epidemiology at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
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  • Andrew Shennan MD, MRCOG,

    1. Matthew J. A. Wilson is a Consultant Anaesthetist in the Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Phillip A. S. Moore is a Consultant Anaesthetist in the Department of Anaesthesia, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham; Andrew Shennan is Professor of Obstetrics at the Maternal and Fetal Research Unit, King’s College, University of London, London; Robert J. Lancashire is a Data Scientist at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham; and Christine MacArthur is Professor of Maternal and Child Epidemiology at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
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  • Robert J. Lancashire BA,

    1. Matthew J. A. Wilson is a Consultant Anaesthetist in the Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Phillip A. S. Moore is a Consultant Anaesthetist in the Department of Anaesthesia, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham; Andrew Shennan is Professor of Obstetrics at the Maternal and Fetal Research Unit, King’s College, University of London, London; Robert J. Lancashire is a Data Scientist at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham; and Christine MacArthur is Professor of Maternal and Child Epidemiology at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
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  • Christine MacArthur PhD

    1. Matthew J. A. Wilson is a Consultant Anaesthetist in the Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Phillip A. S. Moore is a Consultant Anaesthetist in the Department of Anaesthesia, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham; Andrew Shennan is Professor of Obstetrics at the Maternal and Fetal Research Unit, King’s College, University of London, London; Robert J. Lancashire is a Data Scientist at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham; and Christine MacArthur is Professor of Maternal and Child Epidemiology at the Department of Epidemiology, Public Health and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
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Address correspondence to Matthew J. A. Wilson, Department of Anaesthesia at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK.

Abstract:

Background:  Epidural analgesia provides the most effective pain relief in labor, but it is not known if it causes adverse long-term effects. The objective of this study was to assess the long-term effects of two mobile epidural techniques relative to high-dose epidural analgesia in a randomized controlled trial.

Methods:  A total of 1,054 nulliparous women were randomized to traditional high-dose epidural, combined spinal epidural, or low-dose infusion. Women in all groups were followed-up at 12 months postpartum by postal questionnaire to assess long-term symptoms. The primary long-term outcome was backache occurring within 3 months of the birth persisting for longer than 6 weeks. Secondary outcomes were frequent headaches and fecal and urinary stress incontinence.

Results:  No significant differences were found in long-term backache after combined spinal epidural or low-dose infusion relative to high-dose epidural. Significantly less headache occurred in combined spinal epidural analgesia than high-dose epidural (OR: 0.57, 95% CI: 0.36–0.92), but no difference was found for low-dose infusion. Significantly less fecal incontinence (OR: 0.51, 95% CI: 0.30–0.87) and stress incontinence (OR: 0.65, 95% CI: 0.42–1.00) occurred with low-dose infusion.

Conclusion:  Trial evidence showed no long-term disadvantages and possible benefits of low-dose mobile relative to high-dose epidural analgesia. (BIRTH 38:2 June 2011)

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