Effect of lumbar epidural and caudal analgesia on the second stage of labor

ABSTRACT

BACKGROUND: Epidural analgesia is the most effective way of providing pain relief during labor.However, its effect on the second stage of labor is controversial.This study examined the effect of epidural analgesia combined with caudal analgesia on the second stage of labor. METHODS: Forty three multiparous women were divided into three groups, non-epidural group, epidural group and epidural with caudal group.Epidural analgesia was maintained with patient-controlled epidural analgesia (0.09375% ropivacaine with 0.0002% fentanyl) in both the epidural and epidural with caudal groups.The epidural with caudal group was injected with 0.09375% ropivacaine into the caudal epidural space after inserting the lumbar epidural catheter.The assessments made throughout labor included the visual analogue score (VAS), patient's satisfaction, motor block and duration of the second stage. RESULTS: There were no significant differences in the patient's satisfaction, VAS and motor block between the epidural group and epidural with caudal group.There were no significant differences in the duration of the second stage between the non-epidural, epidural and epidural with caudal groups. No cesarean or instrumental deliveries were performed. CONCLUSIONS: Epidural with caudal analgesia offers no additional benefit during the second stage of labor.However, it carries no added risk on the maternal outcome.