Intrathecal Narcotics Are Associated With Prolonged Second-Stage Labor And Increased Oxytocin Use

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Original Research

Intrathecal Narcotics Are Associated With Prolonged Second-Stage Labor And Increased Oxytocin Use

J Fam Pract. 2000 June;49(6):515-520

References

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Our retrospective study design also limited our ability to assess the effectiveness of pain control in the 2 groups. Since objective pain measurements are not part of routine labor monitoring at our hospital, we could only infer the effectiveness of ITN from subjective chart notations or indirect measures of “method failure,” such as additional narcotic doses or second procedures required. Also, since the comparison group is defined by selecting out a certain percentage of “method failures” (ie, women who entered labor intending to use intravenous or no medication but changed their minds and requested ITN), effectiveness of pain control in the 2 groups cannot be directly compared.

Conclusions

The combined findings of a prolongation of the second stage of labor and increased oxytocin augmentation raise concerns that ITN alters the natural course of labor. However, caution is warranted, because selection bias in this retrospective study prohibits any conclusions regarding cause and effect. Prospective randomized trials comparing intrathecal narcotics with epidural analgesia and no spinal analgesia could substantially improve our understanding of the effects of spinal analgesia on the course and outcomes of labor. Objective measures of the effective duration of ITN are also needed, and strategies to enhance effectiveness (such as addition of local anesthetic to the ITN or routine use of a pudendal block in the second stage) also deserve experimental trials. Finally, women’s voices must be heard in evaluating the tradeoffs between analgesic efficacy and side effects. Such tradeoffs may greatly influence their analgesic choices and have an impact on their overall satisfaction with the birthing experience.

Acknowledgments

Our research was funded through the Department of Family Practice and Community Health, University of Minnesota. We acknowledge Deborah Finstad for database management, Dr Bruce Center for assistance with statistical analysis, Dr James Pacala for manuscript review, and Dr Anne Marie Weber-Main for editorial assistance.