OBJECTIVE: Epidural analgesia is associated with a four- to five- fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN: We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.5 degrees F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS: In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.4 degrees F was identical in the acetaminophen and placebo groups (23.8%, p=1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.
RCT Entities:
OBJECTIVE: Epidural analgesia is associated with a four- to five- fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN: We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.5 degrees F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS: In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.4 degrees F was identical in the acetaminophen and placebo groups (23.8%, p=1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.
Authors: Dominique Y Arce; Andrea Bellavia; David E Cantonwine; Olivia J Napoli; John D Meeker; Tamarra James-Todd; Thomas F McElrath; Lawrence C Tsen Journal: PLoS One Date: 2019-11-05 Impact factor: 3.240
Authors: Anna Cartledge; Daniel Hind; Mike Bradburn; Marrissa Martyn-St James; Sophie Davenport; Wei Shao Tung; Hwu Yung; Jeyinn Wong; Matthew Wilson Journal: Br J Anaesth Date: 2022-08-05 Impact factor: 11.719