A Randomized Trial of Intrapartum Analgesia in Women With Severe Preeclampsia

In Brief OBJECTIVE To estimate whether the cesarean delivery rate differs between women with severe preeclampsia who receive intrapartum epidural analgesia versus patient-controlled intravenous opioid analgesia. METHODS Women with severe preeclampsia at at least 24 weeks' gestation were randomly assigned to receive either intrapartum epidural (n = 56) versus patient-controlled intravenous opioid analgesia (n = 60), and each was administered by a standardized protocol. The sample size was selected to have 80% power to detect at least a 50% difference in the predicted intergroup cesarean delivery rates. Data were analyzed by intent to treat. RESULTS Selected maternal characteristics and neonatal outcomes were similar in the two groups. The cesarean delivery rates in the epidural group (18%) and the patient-controlled analgesia group (12%) were similar (P = .35). Women who received epidural analgesia were more likely to require ephedrine for the treatment of hypotension (9% versus 0%, P = .02), but their infants were less likely to require naloxone at delivery (9% versus 54%, P < .001). Epidural analgesia provided significantly better pain relief as determined by a visual analogue intrapartum pain score (P < .001) and a postpartum pain management survey (P = .002). CONCLUSION Compared with patient-controlled intravenous opioid analgesia, intrapartum epidural analgesia did not significantly increase the cesarean delivery rate in women with severe preeclampsia at our level III center, and it provided superior pain relief. In women with severe preeclampsia, intrapartum epidural analgesia, compared with patient-controlled intravenous opioids, did not significantly increase the cesarean rate, and provided superior pain relief.