Regional analgesia – maintenance of regional analgesia (local anaesthetic with opioid versus local anaesthetic without opioid)

Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Elliott RD;

1991224
RCTEvidence level: 1+N=75 (0.125%bupivacaine+fentanyl=24; 0.25%bupivacaine=24; 0.125%bupivacaine=27)women in labour requesting epidural analgesiaIntervention: bupivacaine 0.125%Comparison: bupivacaine plu fentanylFollow-up period: intrapartumOutcome Measures: mode of birth, efficacy, adverse eventsspontaneous vaginal birth
RR 1.00 [0.26 to 3.81]

CS
RR 0.64 [0.10 to 4.15]

duration of second stage
MD −4.00 [−38.21 to 30.21]

Onset of analgesia
MD 9.00 [−94.75 to 112.75]

urinary retention
RR 2.61 [0.75 to 9.11]

no motor block
RR 1.16 [0.29 to 4.62]

total dose
MD 17.00 [−4.13 to 38.13] mg

apgar score less than 7 at 1 min
RR 2.38 [0.41 to 13.75]

apgar score less than 7 at 5 min
RR 2.63 [0.10 to 68.07]

Satisfaction
first stage RR 0.21 [0.05 to 0.87]
second stage RR 1.21 [0.36 to 4.07]
not stated
Enever GR;Noble HA;Kolditz D;Valentine S;Thomas TA;

1991225
RCTEvidence level: 1+N=61 (bupivacaine plus dimorphine=19 ; bupivacaine plus fentanyl=21; bupivacaine alone=21)women in labour requestng epidural analgesiaIntervention: bupivacaine aloneComparison: bupivacaine plus fentanylFollow-up period: intrapartumOutcome Measures: efficacy, mode of birth, adverse outocmesspontaneous vaginal birth
RR 1.00 [0.26 to 3.81]

CS
RR 1.00 [0.18 to 5.63]

hypotension
RR 0.75 [0.17 to 3.31]

pruritis
RR 0.32 [0.01 to 8.26]

nausea/vomiting
RR 0.63 [0.09 to 4.23]

no motor block
RR 0.75 [0.17 to 3.31]
not stated
Russell R;Quinlan J;Reynolds F;

1995226
RCTEvidence level: 1+N=60(30 for each arm)women in labour requesting epidural analgesiaIntervention: 0.125% bupivacaineComparison: 0.0625% bupivacaine plus 2.5mcg/ml fentanylFollow-up period: intrapartumOutcome Measures: efficacy, mode of birthspontaneous vaginal birth
RR 0.79 [0.43 to 1.44]

CS
RR 1.25 [0.37 to 4.21]

duration of second stage
MD −4.00 [−11.27 to 3.27]
not stated
Russell R;Reynolds F;

1996227
RCTEvidence level: 1+N=399 (without opioid=200; with opioid=199)women in labour requesting epidural analgesiaIntervention: 0.0625% bupivacaine plus 2.5mcg/ml fentanylComparison: 0.125% bupivacaineFollow-up period: intrapartumOutcome Measures: efficacy, mode of birth, neonata outcomesspontaneous vaginal birth
RR 0.79 [0.43 to 1.44]

CS
RR 1.25 [0.37 to 4.21]

duration of second stage
MD −7.0 [−24.55 to 10.55]

hypotension
none reported

pruritis
RR 0.04 [0.00 to 0.60]

nausea/vomiting
RR 0.75 [0.18 to 3.07]

no motor block
RR 0.48 [0.30 to 0.77]
not stated
Reynolds F;Russell R;Porter J;Smeeton N;

2003228
RCTEvidence level: 1+N=587 (plain bupivacaine=296; with fentanyl=291)women in labour requesting epidural analgesiaIntervention: plain bupivacaine (0.125%)Comparison: 0.0625% bupivacaine plus opioidFollow-up period: intrapartumOutcome Measures: efficacy, mode of birth, adverse eventsspontaneous vaginal birth
RR 0.90 [0.76 to 1.08]

CS
RR 1.25 [0.37 to 4.21]

duration of second stage
MD −5.00 [−11.31 to 1.31]

Apgar score less than 7 at 1 min
RR 0.88 [0.58 to 1.35]

Apgar score less than 7 at 5 min
RR 10.81 [0.60 to 194.70]
not stated
Porter J;Bonello E;Reynolds F;

1998 Jul 229
RCTEvidence level: 1+N=134(without =70; with=68)women in labour requesting epidural analgesiaIntervention: bupivacaine plus fentanyl for epidural analgesiaComparison: bupivacaine onlyFollow-up period: intrapartumOutcome Measures: efficacy, mode of delivery, adverse eventsNACS>35 at 2 hours
RR 1.07 [0.91 to 1.26]

NACS>35 at 24 hours
RR 1.07 [0.95 to 1.22]
not stated
Chestnut DH;Owen CL;Bates JN;Ostman LG;Choi WW;Geiger MW;

1988230
RCTEvidence level: 1+N=80 (without=39; with=41)women in labour requesting epidural analgesiaIntervention: bupivacaine onlyComparison: bupivacaine plus fentanylFollow-up period: intrapartumOutcome Measures: efficacy, adverse events, mode of birthspontaneous vaginal birth
RR 1.05 [0.74 to 1.50]

CS
RR 1.23 [0.45 to 3.33]

duration of second stage
MD 12.00 [−17.20 to 41.20]

pruritis
RR 0.23 [0.05 to 1.01]

urinary retention
RR 0.69 [0.45 to 1.05]

Nausea/vomiting
RR 1.15 [0.57 to 2.29]

no motor block
RR 0.42 [0.27 to 0.65]
not stated

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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