The effect of the walking epidural technique on maternal pain relief and the progress of labor in nulliparous patients: A randomized controlled trial comparing the effects of standard epidural analgesia and the combined spinal epidural analgesia techniques for labor

ABSTRACT

Background: While the standard lumbar epidural analgesia technique has often been described as the gold standard for pain relief during labor, its disadvantages of delayed onset and the presence of motor blockade to a certain degree pose several constraints to pain burdened mother who also may not want to be confined in the supine position during the entire labor process. An alternative which may address these issues is the combined spinal epidural or walking epidural technique. We embarked on this study to compare both techniques in terms of onset and degree of analgesia and the outcome of labor. Methods: Eighty (80) nulligravid ASA 1-2 term patients were randomly assigned to receive labor pain relief either using the standard continuous lumbar epidural analgesia (CLEA) using .125 percent bupivacaine with fentanyl or the combined spinal epidural analgesia (CSE) technique using intrathecal fentanyl and bupivacaine followed by bupivacaine boluses with fentanyl as needed. Outcome measures studied were Visual Analogue Pain Scores, onset degree and duration of pain relief and the progress and outcome of labor including neonatal outcome. Side effects were also noted. Results: Very significant was the rapid onset of action, denser, and longer duration of pain relief in the CSE group. Likewise a faster rate of cervical dilation resulting in a shorter first stage of labor was noted. Second stage duration and mode of delivery in both groups however did not differ significantly. Maternal satisfaction during the first stage was greater in the CSE group, although overall maternal satisfaction was comparable in both groups. Pruritus, although a significant occurrence in the CSE group did not need any intervention for treatment. No adverse effects on both the neonate and mother were noted. Conclusion: Based on the results of our study, the CSE or walking epidural is a encouraging alternative to laboring mothers, especially those in severe pain requiring rapid and profound relief. Our results show that compared the standard epidural technique, it hastens the rate of first stage labor - but whether ambulation plays a significant role in this aspect needs to be further investigations