Article Text

  1. E. S. Brand1
  1. 1University of Washington School of Medicine, Seattle, WA.


Purpose The regional anesthetic technique of epidural anesthesia provides one of the most effective methods of relieving pain during labor. This technique is not without controversy, however. Many believe that neuraxial analgesia such as this may slow labor and increases the incidence of cesarean and instrumental delivery. Therefore, the purpose of the current investigation is to identify consensus within the literature to provide more clear recommendations to providers and patients, as well as identify areas of controversy in which further study may be necessary.

Methods A systematic review of the literature was performed, including 22 studies and reviews.

Summary All authors considered in this review agree that epidural anesthesia provides the best pain blockade but may increase the need for oxytocin augmentation. Most agree that epidural anesthesia does not increase the rate of cesarean delivery, instrumental/operative vaginal delivery, or difficult delivery. The majority of authors agree that epidural anesthesia is associated with prolongation of the second phase of labor but cite mixed results regarding the first phase.

Conclusions The American College of Obstetricians and Gynecologists currently recommends that the decision to use epidural anesthesia should be based on patients' wishes and other factors, including parity, not a standard amount of cervical dilation. This review of the literature may serve to help summarize the evidence and elucidate some of these factors for informed decision making by patients and practitioners. Further study may be necessary to account for pain as a confounding variable.

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