Comparison of Two Methods of Labor Analgesia

Background

Childbirth is usually the most challenging and painful experience of a mother's life.^[1] Fear of childbirth has increased the cesarean delivery rate. Due to the fact that natural vaginal delivery has many advantages compared with cesarean section and promotion of natural vaginal delivery is considered important by the health care systems, labor analgesia has become a key concern for both puerperal and clinical anesthesiologists.^[2]

At present, labor analgesia methods include non- pharmacological analgesia and pharmacological analgesia. Non-pharmacological analgesia mainly includes acupuncture, massage, yoga and hydrotherapy and the analgesic effect of which is poor although there is no maternal and fetal injury.^[3] For pharmacological analgesia, there are intramuscular analgesics, intravenous analgesics, and spinal analgesia. Among them, intraspinal labor analgesia is the best method for clinical application of analgesia, including continuous epidural analgesia (CEA), combined spinal-epidural anesthesia (CSEA) and continuous spinal anesthesia.^[4,5] Epidural analgesia is considered as a widely practiced analgesic technique in clinic worldwide.^[6] An ideal labor analgesia method should exhibit good analgesic effect, increase subject satisfaction and comfort, and reduce the incidence of adverse pregnancy outcomes and adverse drug reactions without affecting the progress of labor.^[7]

In recent years, with the development of anesthesia technology, combined spinal-epidural anesthesia has increasingly used in labor analgesia because it combines the advantages of epidural anesthesia and spinal anesthesia, including rapid onset, significant analgesic effect, lower drug dosage and fewer side effects.^[8,9] However, there are few reports on the specific anesthesia methods and medication regimens of combined spinal-epidural anesthesia, which is not conducive to guiding clinical work. Here, we compared the clinical effects of combined spinal-epidural anesthesia and continuous epidural anesthesia, to provide guidance for clinical work.

Table 1. Clinical characteristics of subjects (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)	P value
Age, years	26.8 ± 4.2	27.1 ± 3.9	0.483
Height, cm	160.4 ± 4.3	161.3 ± 4.6	0.056
Weight, kg	65.4 ± 16.2	66.3 ± 15.6	0.592
BMI, kg/m²	22.3 ± 3.4	22.2 ± 3.1	0.771
Duration of pregnancy, weeks	38.5 ± 1.3	38.3 ± 1.4	0.161

BMI Body Mass Index. P value of comparison between CSEA and CEA groups

Table 2. Comparison of pain VAS scores at different times in two groups (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)
T₀ (min)	8.32 ± 1.37	8.36 ± 1.35
T₁(min)	3.35 ± 0.64*	3.02 ± 0.67^*#
T₂ (min)	4.22 ± 0.87*	3.84 ± 0.83^*#
T₃ (min)	6.84 ± 1.26*	5.31 ± 1.12^*#

*P < 0.01, vs T₀; ^# P < 0.01, vs CEA group

Table 3. Comparison of labor time in two groups (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)	P value
Onset time (min)	6.32 ± 3.45	3.21 ± 1.42	< 0.001
T₁(min)	524.33 ± 126.46	468.32 ± 114.10	< 0.001
T₂(min)	48.24 ± 10.34	46.09 ± 11.22	0.060
T₃(min)	7.38 ± 0.76	7.24 ± 0.83	0.096
Total labor time (min)	578.29 ± 132.08	512.67 ± 124.38	< 0.001

Table 4. The Apgar scores at 1, 5, and 10 min after birth in two groups (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)	P value
1 min after birth	8.47 ± 0.34	8.41 ± 0.35	0.099
5 min after birth	8.85 ± 0.41	8.83 ± 0.42	0.647
10 min after birth	9.52 ± 0.38	9.48 ± 0.33	0.278

Table 5. Comparison of adverse pregnancy outcomes in two groups (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)	P value
Obstetric apparatus, n (%)	7 (3.89)	8 (4.45)	0.792
Cesarean, n (%)	18 (10.00)	22 (12.22)	0.499
24 h postpartum hemorrhage, n (%)	6 (3.33)	5 (2.78)	0.759
Episiotomy, n (%)	22 (12.22)	16 (8.89)	0.303
Total adverse pregnancy outcomes, n (%)	44 (24.44)	41 (22.78)	0.709

Table 6. Doses of Ropivacaine and Sufentanil in each group. (mean ± SD)
	CEA (n = 180)	CSEA (n = 180)	P value
Ropivacaine	39.88 ± 4.52	38.42 ± 3.16	< 0.001
Sufentanil	19.98 ± 6.66	16.01 ± 5.26	< 0.001

Table 7. Comparison of adverse drug reactions in two groups
	CEA (n = 180)	CSEA (n = 180)	P value
Nausea and vomiting, n (%)	20 (11.11)	8 (4.44)	0.018
Pruritus, n (%)	12 (6.67)	4 (2.22)	0.041
Uroschesis, n (%)	8 (4.44)	4 (2.22)	0.240
Respiratory depression, n (%)	4 (2.22)	2 (1.11)	0.410
Total adverse drug reactions, n (%)	44 (24.44)	18 (10.00)	< 0.001
Subject satisfaction, n (%)	120 (66.67)	150 (83.33)	< 0.001