Epidural Analgesia During Labor and Maternal Fever

Observational studies suggest that epidural analgesia for labor may be an independent risk factor for maternal fever. A recent randomized trial in women with low-risk pregnancies enrolled 715 women at term who received either epidural analgesia with bupivacaine and fentanyl or patient-controlled intravenous analgesia (PCIA) with meperidine. The epidural began with increments of 0.25 percent bupivacaine, followed by a continuous infusion of 0.125 percent bupivacaine with 2 μg/ml fentanyl. Women assigned to PCIA received 50 mg of meperidine with 25 gm of promethazine at their first request, followed by 10 mg of meperidine every 10 minutes for the first hour and then 15 mg every 10 minutes as needed. Tympanic membrane temperature was monitored during labor. The final study population included 243 women given epidural analgesia who completed the study and 259 randomly assigned to receive PCIA. Fever, defined as a temperature of 38.0°C or higher, developed during labor in 15 percent of women assigned to receive an epidural and in 4 percent of the PCIA group. The difference was significant (24 vs. 5 percent) only for nulliparous women. Age and body size did not predict the development of fever, but black women were febrile only half as often as white women. Maternal fever correlated with labor lasting longer than 12 hours and use of oxytocin to augment labor. After logistic regression analysis, epidural analgesia remained independently associated with maternal fever, with an odds ratio (OR) of 4.0. Nulliparity (OR = 4.1) and prolonged labor (OR = 5.4) also were predictive factors. No infant became septic, and there were no neonatal deaths. Epidural analgesia is associated with maternal fever, but only in a relatively small group of women who usually are nulliparous and have prolonged labors. The authors do not believe that epidurals should be avoided because of fear of inducing maternal fever or having to investigate possible neonatal sepsis. Anesthesiology 1999;90:1271–1275