Local versus Systemic Application of Opioids for Labor Analgesia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Jun ,  LIN Xuemei , LUO linli , MA Yushan

Department of Anesthesia, West China Second University Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIN Xuemei, Email: bambooskx@163.com

Keywords：

Opioids; Labor analgesia; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20080148

Video：

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Objective 　To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia.
Methods 　We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software.
Results 　A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01).
Conclusion 　Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.

Citation： ZHOU Jun,LIN Xuemei,LUO linli,MA Yushan. Local versus Systemic Application of Opioids for Labor Analgesia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(8): 652-661. doi: 10.7507/1672-2531.20080148 Copy

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2.	Tan TK. Epidural analgesia in obstetrics. Ann Acad Med Singapore, 1998, 27(2): 235-242.
3.	刘关键. 统计方法在循证医学中的应用. 见: 李幼平, 主编. 循证医学. 北京: 高等教育出版社, 2003. 50-66.
4.	Clark A, Carr D, Loyd G, et al. The influence of epidural analgesia on cesarean delivery rates: a randomised, prospective clinical trial. Am J Obstet Gynecol, 1998, 179: 1527-1533.
5.	Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology, 1998, 89: 1336-1344.
6.	Halpern SH, Muir H, Breen TW, et al. A multicentre randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labour. Anaesth Analg, 2004, 99: 1532-1538.
7.	Head B, Owen J, Vincent R, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia. Obstet Gynecol, 2002, 99: 452-457.
8.	Hill JB, Alexander JM, Sharma SK, et al. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstet Gynecol, 2003, 102(2): 333-337.
9.	Jain S, Arya S, Gopalan S, et al. Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor. Int J Gynecol Obstet, 2003, 83:19-27.
10.	Lucas M, Sharma S, Leveno K, et al. A randomized trial of labor epidural analgesia in women with preeclampsia. Anesthesiology, 1998, 88(4 Suppl): A25.
11.	Ramin S, Gambling DR, Lucas MJ, et al. Randomised trial of epidural versus intravenous analgesia during labour. Obstet Gynecol, 1995, 86(5): 783-789.
12.	Sharma SK, Sidawi JE, Raminas SM, et al. Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology, 1997, 87(3): 487-494.
13.	Sharma SK, Alexander JM, Messick G, et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology, 2002, 96(3): 546-551.
14.	Vella LM, Willatts DG, Knott C, et al. Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia. Anaesthesia, 1985, 40(8): 741-747.
15.	Wong CA, Scavone BM, Peaceman AM, et al. The risk of caesarean delivery with neuroaxial analgesia given early versus late in labour. N Engl J Med, 2005, 352: 655-665.

1. 徐惠芳. 分娩镇痛及其研究进展. 中华麻醉学杂志, 2001, 21(5): 319-320.
2. Tan TK. Epidural analgesia in obstetrics. Ann Acad Med Singapore, 1998, 27(2): 235-242.
3. 刘关键. 统计方法在循证医学中的应用. 见: 李幼平, 主编. 循证医学. 北京: 高等教育出版社, 2003. 50-66.
4. Clark A, Carr D, Loyd G, et al. The influence of epidural analgesia on cesarean delivery rates: a randomised, prospective clinical trial. Am J Obstet Gynecol, 1998, 179: 1527-1533.
5. Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology, 1998, 89: 1336-1344.
6. Halpern SH, Muir H, Breen TW, et al. A multicentre randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labour. Anaesth Analg, 2004, 99: 1532-1538.
7. Head B, Owen J, Vincent R, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia. Obstet Gynecol, 2002, 99: 452-457.
8. Hill JB, Alexander JM, Sharma SK, et al. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstet Gynecol, 2003, 102(2): 333-337.
9. Jain S, Arya S, Gopalan S, et al. Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor. Int J Gynecol Obstet, 2003, 83:19-27.
10. Lucas M, Sharma S, Leveno K, et al. A randomized trial of labor epidural analgesia in women with preeclampsia. Anesthesiology, 1998, 88(4 Suppl): A25.
11. Ramin S, Gambling DR, Lucas MJ, et al. Randomised trial of epidural versus intravenous analgesia during labour. Obstet Gynecol, 1995, 86(5): 783-789.
12. Sharma SK, Sidawi JE, Raminas SM, et al. Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology, 1997, 87(3): 487-494.
13. Sharma SK, Alexander JM, Messick G, et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology, 2002, 96(3): 546-551.
14. Vella LM, Willatts DG, Knott C, et al. Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia. Anaesthesia, 1985, 40(8): 741-747.
15. Wong CA, Scavone BM, Peaceman AM, et al. The risk of caesarean delivery with neuroaxial analgesia given early versus late in labour. N Engl J Med, 2005, 352: 655-665.

Chinese Journal of Evidence-Based Medicine

Local versus Systemic Application of Opioids for Labor Analgesia: A Systematic Review

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