A Comparison of Intrathecal and Epidural Analgesia and Its Effect on Length of Labor

A retrospective study was conducted to determine the efifects of intrathecal analgesia on length of labor. There have been a number of investigations which show contradictory evidence as to the effect of epidural (EPI) analgesia on the progress of labor. Combined spinal-epidural (CSE) and intrathecal analgesia (ITA) techniques have been used to provide effective pain relief for parturients, but currently there are few data comparing EPI, CSE, and ITA techniques and their effect on progress of labor. Intrathecal opioids provide immediate pain relief for the parturient without autonomic, sensory or motor blockade. All are associated with prolongation of labor and increased incidence of instmmental delivery. A 1995 study reported CSE for labor analgesia is associated with shorter duration of first stage in primiparas (Campbell et al). The last two hundred thirteen uncomplicated obstetric charts were reviewed in a 70-bed Air Force hospital which currently provides EPI, CSE, and ITA for their obstetric department. The study consisted of four groups: (1) CSE n=76 (2) EPI n= 41 (3) ITA n=49 and (4) NR (no regional analgesia) n=47. Demographic data was also collected. It was found that length of first stage labor was significantly less for those who received ITA (p<.00\) as compared to all other groups. Second stage labor was significantly shorter for the NR group as compared to CSE (p=.000) and EPI (p=.006) groups. There was no significant difference between length of second stage for ITA and NR groups ITA analgesia shortened first stage most significantly (p=.006) in both primiparas and muhiparas Stage two was significantly prolonged for both primiparas (p=.047) and multiparas {p=.0l2) in the CSE group. Since CSE analgesia during labor is both versatile and requires less re-dosing of the epidural catheter, thus less manpower hours, implications for use in anesthesia departments unable to offer a full obstetric regional analgesia service are made.