Comparative Study of the Effect of Early Versus Late Initiation of Epidural Analgesia on Labour

Background: Epidural analgesia also known as regional analgesia has been established as a safe and an effective method of pain relief during labor. It was thought that epidurals may possibly interfere with labor and consequently increase the rate of cesarean deliveries or instrumental deliveries or other adverse effect. . A more recent review concluded that epidural analgesia is not associated with such a risk. But, the timing of placement of epidural analgesia has been a controversial issue and how early laboring women can benefit from epidural analgesia is still debated. Hence this comparative study determines the effect of early versus late initiation of epidural analgesia on labor.Objective: To compare the effect of early versus late initiation of epidural analgesia on the duration of labour and the mode of delivery.Methodology: A randomized trial in which 100 term women in early labor at less than3 cm of cervical dilatation were assigned to either immediate initiation of epidural analgesia at first request (50 women) or delay of epidural until the cervix was dilated to at least 4 cm (50 women).Results: At initiation of the epidural, the mean cervical dilatation was 3.1 cm in the early epidural group and 4.4 cm in the late group (P value 0.0000). The mean duration from initiation to full dilatation was significantly shorter in the early compared to the late epidural group: 5.57 hours and 6.3hours respectively amongst primigravida (P = 0.0001) and 3.04 hours and 4.07 hours respectively amongst multigravida. The rates of cesarean section were not significantly different between the groups i.e. 6% and 6% in both early and late groups (P = 0.82) which was not significant. When questioned after delivery regarding their next labor, the women indicated a preference for early epidural.Conclusion: Epidural analgesia in the early labour, following the first request for epidural at cervical dilation of 2-3 cm does not prolong the progression of labor and does not increase the rate of Cesarean deliveries , instrumental vaginal deliveries , and other adverse effects in laboring women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more. Furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women