Q&A

Early intrathecal analgesia does not increase cesarean sections

J Fam Pract. 2005 June;54(6):493-500
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  • Clinical Question: Does early administration of neuraxial analgesia in labor increase the risk of cesarean delivery?
  • Study Design: Randomized controlled trial (nonblinded)
  • Allocation: Concealed
  • Setting: Inpatient (ward only)
  • Synopsis: Epidural analgesia, when given before a cervical dilatation of 4 cm, has been associated with higher cesarean delivery rate. Systemic narcotics are often used for women requesting analgesia in early labor.
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Bottom Line

Intrathecal fentanyl followed by epidural bupivacaine plus fentanyl, if needed for pain relief, in early labor is not associated with a higher cesarean delivery than systemic hydromorphone for early labor. The neuraxial approach also provides more effective analgesia and a shorter mean duration of first-stage labor. (LOE=1b)

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