Epidural blocks provide superior pain relief over systemically administered opioids during labour, though their effect on labour progress and operative delivery rates remains controversial.
Does epidural analgesia affect the course and outcome of labour compared to systemically administered opioids?
While epidural analgesia provides superior pain relief during labor compared to systemic opioids, its impact on labor progression and operative delivery rates remains unclear due to study limitations.
The potential effects of epidural analgesia on the progress and outcome of labour have been the subject of lasting controversy. Retrospective reviews indicate that epidurals are associated with longer labours and/or an increase in the incidence of instrumental or operative delivery. Similar results were obtained in non-randomized prospective studies. None of them established a causal relationship, because without randomization the selection bias cannot be ruled out. Other factors, such as premature rupture of membranes and maternal socioeconomic status, may affect the outcome of labour. It was also reported that introduction of the on-demand epidural service did not increase the primary caesarean section rate. The few prospective randomized studies are contradictory and not very reliable owing to small patient populations and high cross-over rates. There is, however, unanimity among the authors regarding the superiority of pain relief provided by epidural blocks over systemically administered opioids.
Finster et al. (1998) conducted a review in Labour. Epidural analgesia vs. Systemically administered opioids was evaluated on Pain relief and progress/outcome of labour. Epidural blocks provide superior pain relief over systemically administered opioids during labour, though their effect on labour progress and operative delivery rates remains controversial.
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