M J A Wilson1, C Macarthur, A Shennan. 1. Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. matthew.wilson@sth.nhs.uk
Abstract
BACKGROUND: Dense perineal block from epidural analgesia increases the risk of urinary catheterization in labour. Mobile epidurals using low-dose local anaesthetic in combination with opioid preserve maternal mobility and may reduce the risk of bladder dysfunction. We conducted a three-arm randomized controlled trial to compare high-dose epidural pain relief with two mobile epidural techniques. METHODS: A total of 1054 primparous women were randomized to receive high-dose bupivacaine, epidural analgesia (Control), combined spinal epidural (CSE), or low-dose infusion (LDI). The requirement for urinary catheterization during labour and postpartum was recorded. Both end points were pre-specified secondary trial outcomes. Women were evaluated by postnatal interview, when their bladder function had returned to normal. RESULTS: Relative to Control, more women who received mobile epidural techniques maintained the ability to void urine spontaneously at any time (Control 11%, CSE 31% and LDI 32%) and throughout labour (Control 3.7%, CSE 13% and LDI 14%), for both mobile techniques P<0.01. There was no difference in the requirement for catheterization after delivery. Women in the CSE group reported a more rapid return of normal voiding sensation, relative to high-dose Control (P=0.02). CONCLUSIONS: Relative to conventional high-dose block, mobile epidural techniques encourage the retention of normal bladder function and reduce the risk of urinary catheterization in labour.
RCT Entities:
BACKGROUND: Dense perineal block from epidural analgesia increases the risk of urinary catheterization in labour. Mobile epidurals using low-dose local anaesthetic in combination with opioid preserve maternal mobility and may reduce the risk of bladder dysfunction. We conducted a three-arm randomized controlled trial to compare high-dose epidural pain relief with two mobile epidural techniques. METHODS: A total of 1054 primparous women were randomized to receive high-dose bupivacaine, epidural analgesia (Control), combined spinal epidural (CSE), or low-dose infusion (LDI). The requirement for urinary catheterization during labour and postpartum was recorded. Both end points were pre-specified secondary trial outcomes. Women were evaluated by postnatal interview, when their bladder function had returned to normal. RESULTS: Relative to Control, more women who received mobile epidural techniques maintained the ability to void urine spontaneously at any time (Control 11%, CSE 31% and LDI 32%) and throughout labour (Control 3.7%, CSE 13% and LDI 14%), for both mobile techniques P<0.01. There was no difference in the requirement for catheterization after delivery. Women in the CSE group reported a more rapid return of normal voiding sensation, relative to high-dose Control (P=0.02). CONCLUSIONS: Relative to conventional high-dose block, mobile epidural techniques encourage the retention of normal bladder function and reduce the risk of urinary catheterization in labour.
Authors: Nigel Lee; Lena B Mårtensson; Caroline Homer; Joan Webster; Kristen Gibbons; Helen Stapleton; Natalie Dos Santos; Michael Beckmann; Yu Gao; Sue Kildea Journal: BMC Pregnancy Childbirth Date: 2013-05-03 Impact factor: 3.007
Authors: Shaul Cohen; Renu Chhokra; Mark H Stein; John T Denny; Shruti Shah; Adil Mohiuddin; Rotem Naftalovich; Rong Zhao; Anna Pashkova; Noah Rolleri; Arpan G Patel; Christine W Hunter-Fratzola Journal: J Anaesthesiol Clin Pharmacol Date: 2015 Oct-Dec