Outcomes of trials of women receiving epidural infusions of low concentration local anaesthetic or parenteral opioids
| Outcome | References of trials | No (total No) in epidural group | No (total No) in opioid group | Odds ratio (95% CI) | % rate difference (95% CI) |
|---|---|---|---|---|---|
| Caesarean section: | |||||
| Overall | 20; 22-27 | 178/1473 | 168/1489 | 1.03 (0.71 to 1.48) | 1.18 (−2.66 to 5.01) |
| Excluding Thorp 1993 | 20; 23-27 | 166/1425 | 167/1444 | 1.01 (0.80 to 1.28) | −0.29 (−2.49 to 1.90) |
| Dystocia | 22-27 | 102/1276 | 99/1300 | 1.00 (0.64 to 1.58) | 0.42 (−2.91 to 3.74) |
| Fetal distress | 22-27 | 64/1276 | 55/1300 | 1.15 (0.79 to 1.67) | 0.59 (−0.79 to 1.97) |
| Patients in spontaneous labour | 22-24; 26; 27 | 87/942 | 82/954 | 1.08 (0.65 to 1.82) | 1.65 (−2.99 to 6.29) |
| Instrumental vaginal delivery: | |||||
| Overall | 22-27 | 355/1276 | 289/1300 | 1.63 (1.12 to 2.37) | 6.19 (2.46 to 9.91) |
| Excluding elective forceps | 22; 25-27 | 292/1071 | 241/1087 | 1.56 (0.99 to 2.46) | 6.16 (3.00 to 9.33) |
| Excluding elective forceps and induced labour | 22; 26; 27 | 132/540 | 92/552 | 2.11 (0.95 to 4.65) | 8.14 (4.25 to 12.03) |
| Total operative delivery: | |||||
| Caesarean section, forceps, and vacuum assisted deliveries | 22-27 | 524/1276 | 446/1300 | 1.63 (1.09 to 2.42) | 9.70 (2.40 to 17.00) |
| Excluding elective forceps | 22; 25-27 | 441/1071 | 373/1087 | 1.55 (1.03 to 2.32) | 8.57 (1.48 to 15.65) |
| Mean duration of second stage (minutes) | 22-24; 26 | 64.5 | 49.3 | 15.2* (2.1 to 28.2) | — |
| Non-compliance with treatment allocation | 22-27 | 221/1276 | 607/1300 | 0.19 (0.11 to 0.33) | −23.73 (−41.40 to −6.03) |
| Cross over to other treatment | 22-27 | 186/1276 | 592/1300 | 0.10 (0.05 to 0.22) | −25.83 (−46.65 to −5.01) |
| Oxytocin: | |||||
| Required after analgesia | 22; 26 | 121/274 | 87/278 | 1.75 (1.23 to 2.48) | 13.19 (5.22 to 21.16) |
| Use overall | 22-24; 26; 27 | 467/783 | 424/799 | 1.35 (0.88 to 2.07) | 6.72 (−2.72 to 16.17) |
| Neonate details: | |||||
| Apgar score <7 at 5 minutes | 22; 24; 26; 27 | 13/923 | 17/939 | 0.72 (0.26 to 2.04) | −0.55 (−2.21 to 1.12) |
| Umbilical artery pH <7.2 | 22; 24; 26 | 23/423 | 31/418 | 0.72 (0.40 to 1.27) | −2.45 (−5.51 to 0.61) |
| Required naloxone | 23; 26 | 0/275 | 14/284 | 0.10 (0.01 to 0.89) | −4.38 (−7.77 to −0.99) |
Mantel-Haenszel random effects models used in all analyses.
* Weighted mean difference.