Effect of Epidural versus Parenteral Opioid Analgesia on Labor Pain and Maternal and Neonatal Outcomes among Jordanian Women: A Retrospective Study

Article Sidebar

PDF
Published: Oct 31, 2021
Keywords:
Epidural analgesia, Labor, Opioids, Pain, Parenteral analgesia

Main Article Content

Heba Khalil
Applied Science Private University, Faculty of Nursing, 21 Al Arab St., Amman, Jordan 11931
Abedalmajeed Shajrawi
Applied Science Private University, Faculty of Nursing, 21 Al Arab St., Amman, Jordan 11931
Aaliyah Momani
Applied Science Private University, Faculty of Nursing, 21 Al Arab St., Amman, Jordan 11931
Dalia Khalil
Wayne State University, College of Nursing, 42 W. Warren Ave. Detroit, MI, USA 48202
Raghad Abdelkader
Applied Science Private University, Faculty of Nursing, 21 Al Arab St., Amman, Jordan 11931

Abstract

Introduction: Pain is a major concern during labor. Opioids commonly used to reduce pain during childbirth. However, the most effective route for opioid administration remains controversial. Thus, this study aimed to compare the effect of epidural and parenteral opioid analgesia on pain relief, opioid consumption, opioid-related side effects, and maternal and neonatal outcomes during labor. Methods: This was a retrospective chart review of Jordanian Arab pregnant women admitted for an uncomplicated normal vaginal birth. Data extracted from patients’ medical records and analyzed with t-test for parametric variables and chi-square and fisher’s exact tests for non-parametric variables. Results: Women with epidural analgesia had less pain (t = -32.96, p < .001), consumed less opioids (t = -5.23, p <.001) and complained of fewer opioid side effects (t = -10.35, p < .001) compared to those with parenteral analgesia. However, they had a longer duration of labor (t = 2.05, p < .05) and hospital stay (t = 6.13, p < .001). Induced labor (χ2= 10.93, p < .001) and cesarean section (χ2 = 19.09, p < .001) were higher in women with epidural analgesia and their neonates had lower Apgar scores at 1 minute (t = -2.75, p < .05) and 5 minutes (t = -2.47, p < .05) after birth and higher incidence of fetal heart rate abnormalities (χ2= 5.95, < .05). Conclusion: The use of epidural analgesia is more effective in relieving labor pain compared with parenteral analgesia. However, it is associated with negative maternal and neonatal outcomes.

Downloads

Download data is not yet available.

Article Details

How to Cite
Khalil, H., Shajrawi, A., Momani, A., Khalil, D., & Abdelkader, R. (2021). Effect of Epidural versus Parenteral Opioid Analgesia on Labor Pain and Maternal and Neonatal Outcomes among Jordanian Women: A Retrospective Study. Malaysian Journal of Medicine and Health Sciences, 17(4), 245–250. Retrieved from http://mjmhsojs.upm.edu.my/index.php/mjmhs/article/view/488
Issue
Vol. 17 No. 4 (2021)
Section
Original Articles

References

UNICEF. Birth registration - UNICEF DATA ;2018. Available from: https://data.unicef.org/

Olza I, Leahy-Warren P, Benyamini Y, Kazmierczak M, Karlsdottir SI, Spyridou A, et al. Women’s psychological experiences of physiological childbirth: a meta-synthesis. BMJ Open. 2018;8(10):e020347.

Labor S, Maguire S. The Pain of Labour. Rev Pain. 2008;2(2):15-9.

Chestnut D, Polley L, Wong C, Tsen L. Chestnut’s Obstetric Anesthesia: Principles and Practice. 4 ed: Mosby; 2009 15th April 2009. 1248 p.

Iravani M, Zarean E, Janghorbani M, Bahrami M. Women’s needs and expectations during normal labor and delivery. J Educ Health Promot. 2015;4:6.

Whitburn LY, Jones LE, Davey MA, Small R. Women’s experiences of labour pain and the role of the mind: an exploratory study. Midwifery. 2014;30(9):1029-35.

Medrzycka-Dabrowska W, Czyz-Szypenbejl K, Pietrzak J. A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate. Ginekol Pol. 2018;89(8):460-7.

Baftiu N, Hadri B, Mustafa A. Comparison of epidural morphine versus intramuscular morphine for postoperative analgesia. Med Arh. 2010;64(4):231-4.

Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016;7:CD001893.

Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011(12):CD000331.

Antonakou A, Papoutsis D. The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series. Obstet Gynecol Int. 2016;2016:5740534.

Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst Rev. 2018;8:CD010434.

Oladokun A, Eyelade O, Morhason-Bello I, Fadare O, Akinyemi J, Adedokun B. Awareness and desirability of labor epidural analgesia: a survey of Nigerian women. Int J Obstet Anesth. 2009;18(1):38-42.

Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag. 2012;2(3):219-30.

Patanwala AE, Duby J, Waters D, Erstad BL. Opioid conversions in acute care. Ann Pharmacother. 2007;41(2):255-66.

Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018;6:CD007396.

Hincz P, Podciechowskil L, Grzesiak M, Horzelski W, Wilczyflski J. Epidural analgesia during labor: a retrospective cohort study on its effects on labour, delivery and neonatal outcome. Ginekol Pol. 2014;85(12):923-8.

Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural analgesia on labour, mode of delivery and neonatal outcome in nullipara of India, 2011-2014. J Clin Diagn Res. 2014;8(10):OC03-6.

Herrera-Gomez A, De Luna-Bertos E, Ramos- Torrecillas J, Ocana-Peinado FM, Ruiz C, Garcia-Martinez O. Risk Assessments of Epidural Analgesia During Labor and Delivery. Clin Nurs Res. 2018;27(7):841-52.

Deshmukh VL, Ghosh SS, Yelikar KA, Gadappa SN. Effects of Epidural Labour Analgesia in Mother and Foetus. J Obstet Gynaecol India. 2018;68(2):111- 6.

Papalkar J, Shrivastava D. Labour EA. . Int J Biol Med Res 2013;4((1):2707–12.

Cheng YW, Shaffer BL, Nicholson JM, Caughey AB. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol. 2014;123(3):527-35.

Bannister-Tyrrell M, Ford JB, Morris JM, Roberts CL. Epidural analgesia in labour and risk of caesarean delivery. Paediatr Perinat Epidemiol. 2014;28(5):400-11.

Herrera-Gomez A, Garcia-Martinez O, Ramos- Torrecillas J, De Luna-Bertos E, Ruiz C, Ocana- Peinado FM. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015;31(6):613-6.

Tornell S, Ekeus C, Hultin M, Hakansson S, Thunberg J, Hogberg U. Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study. Acta Anaesthesiol Scand. 2015;59(4):486-95.

Engel N, Velde M, Nijhuis J, Marcus M. Labour analgesia effects on foetal heart rate. A mini-review. Open Journal of Obstetrics and Gynecology. 2011;1(3):113-20.

Korb D, Bonnin M, Michel J, Oury JF, Sibony O. [Analysis of fetal heart rate abnormalities occurring within one hour after laying of epidural analgesia]. J Gynecol Obstet Biol Reprod (Paris). 2013;42(6):564-9.

Wolfler A, Salvo I, Sortino G, Bonati F, Izzo F. Epidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes. Minerva Anestesiol. 2010;76(5):340-5.

Martinez AH, Almagro JJR, Garcia-Suelto MM, Barrajon MU, Alarcon MM, Gomez-Salgado J. Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study. Int J Environ Res Public Health. 2018;15(10).