Combo treatment might beat epidural to ease labor, study says

March 5, 2013
Combo treatment might beat epidural to ease labor: study
But experts say decision for pain relief still lies with woman and her doctor.

(HealthDay)—In the first stage of labor, a combined spinal-epidural technique provides faster and better pain relief compared to traditional epidural pain relief, a new study suggests.

The research included 800 healthy women who required during childbirth, and who were divided into two groups. One group received standard epidural pain relief, which involves injections of and into the epidural space, inside the membranes covering the spinal cord.

The other group received the combination approach, which starts with medications injected into the intrathecal space, the deeper space directly around the , before using an epidural injection.

After the initial epidural or intrathecal injections, both groups received patient-controlled epidural analgesia. The effectiveness of pain relief, rated on a 0-to-10 scale, was compared at different times during labor and delivery.

During the first state of labor, the typical was 1.4 (out of 10) for women receiving the combo therapy and 1.9 for those receiving standard epidural analgesia. This difference was statistically significant, according to a team led by Dr. David Gambling of Sharp Mary Birch Hospital for Women and in San Diego.

The study also found that complete pain relief was achieved an average of 11 minutes faster among women in the combo therapy group than those in the standard epidural group. Women who got the combination of were also less likely to require additional epidural "top-up" doses to maintain good pain control.

Side effects were similar in both groups and there was no significant difference in the type of delivery, with cesarean section rates of 14 percent to 16 percent, concluded the study, which is published in the March issue of the journal Anesthesia & Analgesia.

Experts agreed, however, that pain relief during labor is often a case-by-case decision, and the combination approach might have its own drawbacks.

"The study confirms what we know previously—namely, that the [combination approach] provides faster onset pain relief [by a few minutes] but is associated with a greater incidence of side effects including itching and low fetal heart rates," said Dr. Grant Gilbert, an obstetrician/gynecologist at NYU Langone Medical Center in New York City.

He added, however, that even though the rate of low fetal heart rate was a bit higher among women in the study who got the combination pain relief, "no patient required emergency cesarean for this fetal heart rate problem."

Gilbert also added that some doctors avoid the intrathecal approach due to a higher risk for meningitis, although this is an "admittedly rare complication" and there were no such incidents in the study.

"The bottom line is that both epidural and [the combination] techniques may be used to provide profound pain relief during labor," said Gilbert, who is also associate professor in the department of anesthesiology at NYU Langone. "Ultimately, each practitioner administers the type of analgesia that s/he considers to be best for their patient."

Another expert said the combination approach might have an edge in many cases.

"Combined spinal anesthesia offers significantly better and faster relief for patients in labor, [and] there was no increase in side effects or cesarean sections, either," said Dr. Jennifer Wu, ob/gyn at Lenox Hill Hospital in New York City. "For patients who desire pain relief in , this is good information."

Explore further: Pain relief: Poor evidence for non-drug approaches in labor

More information: The American Society of Anesthesiologists has more about pain management during childbirth.

Related Stories

Pain relief: Poor evidence for non-drug approaches in labor

March 13, 2012

There is better evidence for the effectiveness of drug-based approaches for relieving labour pains than non-drug approaches. These are the findings of an all-encompassing publishing in The Cochrane Library, which draws together ...

Inhaled pain relief in early labor is safe and effective

September 11, 2012

Inhaled pain relief appears to be effective in reducing pain intensity and in giving pain relief in the first stage of labour, say Cochrane researchers. These conclusions came from a systematic review that drew data from ...

Recommended for you

Scientists convert skin cells into placenta-generating cells

October 12, 2015

Regenerative medicine is a new and expanding area that aims to replace lost or damaged cells, tissues or organs in the human body through cellular transplantation. Embryonic stem cells (ESCs) are pluripotent cells that are ...

Genes linked with malaria's virulence shared by apes, humans

October 12, 2015

The malaria parasite molecules associated with severe disease and death—those that allow the parasite to escape recognition by the immune system—have been shown to share key gene segments with chimp and gorilla malaria ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.