Reflections on the topic of the impact of epidural analgesia on the outcome of childbirth


  • E. V. Grizhimalsky The Department of Anesthesiology and Intensive Care of Clinic “Leleka”, Kyiv


birth, pain, epidural analgesia, c-section


Relieving the pains of childbirth is a very important aspect of obstetric care organization. Effective relieving using neuroaxial analgesia with solutions of local anesthetics in low concentration is a safe method of anesthesia for labor. There is no need to linger with the onset of epidural analgesia in labor, it can be started after the woman’s first request for anesthesia. Epidural analgesia does not lead to an increase in the probability of caesarean section compared with the parenteral administration of narcotic analgesics. It can lead to an increase in the likelihood instrumental delivery through the natural birth canal. The use of epidural analgesia does not affect the risk of negative neonatal outcomes. For epidural analgesia, it is necessary to use a low concentration of local anesthetics in combination with narcotic analgesics.


Download data is not yet available.


Halpern S. H. Patient-controlled epidural analgesia for labor / Halpern S. H., Carvalho B. // Anesth Analg. – 2009. – 108. – P. 921–928.

Hinova A. Systemic remifentanil for labor analgesia / Hinova A., Fernando R. // Anesth Analg. – 2009. – 109. – P. 1925–1929.

Niehaus L. S. The effects of epidural anesthesia ontype of delivery / Niehaus L. S., Chaska B. W., Nesse R. E. // J Am Board Fam Pract. – 1988. – 1. – P. 238–244.

Lieberman E. Association of epidural analgesia with cesarean delivery in nulliparas / Lieberman E., Lang J. M., Cohen A. et al. // Obstet Gynecol. – 1996. – 88. – P. 993–1000.

Hess P. E. An association between severe labor pain and cesarean delivery / Hess P. E., Pratt S. D., Soni A. K. et al. // Anesth Analg. – 2000. – 90. – P. 881–886.

Leighton B. L. Epidural analgesia and the progress of labor / Leighton B. L., Halpern S. H. // Evidence-based obstetric anesthesia / Halpern S. H., Douglas M. J. – Malden, Massachusetts : BlackwellPublishing, 2005. – Р. 10–22.

Bofill J. A. Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia / Bofill J. A., Vincent R. D., Ross E. L. et al. // Am J Obstet Gynecol. – 1997. – 177. – P. 1465–1470.

Birnbach D. J. Combined spinal-epidural (CSE) for labor and delivery / Birnbach D. J., Ojea L. S. // Int Anesthesiol Clin. – 2002. – 40. – P. 27–48.

Tsen L. C. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? / Tsen L. C., Thue B., Datta S., Segal S. // Anesthesiology. – 1999. – 91. – P. 920–925.

Gambling D. R. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate / Gambling D. R., Sharma S. K., Ramin S. M. et al. // Anesthesiology. – 1998. – 89. – P. 1336–1344.

Norris M. C. Combined spinal-epidural versus epidural labor analgesia / Norris M. C., Fogel S. T., Conway-Long C. // Anesthesiology. – 2001. – 95. – P. 913–920.

Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial //Lancet. – 2001. – 358. – P. 19–23.

Comparative Obstetric Mobile Epidural Trial Study Group, UK Randomized controlled trial comparing traditional with two ‘mobile’ epidural techniques: anesthetic and analgesic efficacy // Anesthesiology. – 2002. – 97. – P. 1567–1575.

Simmons S. W. Combined spinal-epidural versus epidural analgesia in labour / Simmons S. W., Cyna A. M., Dennis A. T., Hughes D. // Cochrane Database Syst Rev. – 2007. – 3: Art. no.: CD003401. doi: 10.1002/14651858.CD003401.pub2.

Goetzl L. M. ACOG Committee on Practice B: ACOG Practice Bulletin / Goetzl L. M. // Clinical management guidelines for obstetriciangynecologists number 36, July 2002. Obstetric analgesia and anesthesia. Obstet Gynecol. – 2002. – 100. – P. 177–191.

Ohel G. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial / Ohel G., Gonen R., Vaida S. et al. // Am J Obstet Gynecol. – 2006. – 194. – P. 600–605.

Wong C. A. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor / Wong C. A., Scavone B. M., Peaceman A. M. et al. // N Engl J Med. – 2005. – 352. – P. 655–665.

Wong C. A. Early compared with late neuraxial analgesia in nulliparous labor induction: a randomized controlled trial / Wong C. A., McCarthy R. J., Sullivan J. T. et al. // Obstet Gynecol. – 2009. – 113. – P. 1066–1074.

Wang F. Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized controlled trial / Wang F., Shen X., Guo X. et al. // Anesthesiology. – 2009. – 111. – P. 871–880.



How to Cite

Grizhimalsky EV. Reflections on the topic of the impact of epidural analgesia on the outcome of childbirth. PMJUA [Internet]. 2017 Sep. 1 [cited 2023 Feb. 8];2(3):59-65. Available from:



Clinical thinking