Abstract
Most women experience severe pain during labor. Epidural analgesia is considered the gold standard of labor analgesia and is achieved by infusing local anesthetic and opioids (e.g. fentanyl) in to the epidural space. To further enhance analgesia efficacy, adjuvants such as adrenaline may be used, and different modes of administration (e.g. continuous infusions (CEI), patient controlled boluses or programmed intermittent boluses (PIEB)) has been studied.
The aim of this thesis was to investigate different aspects of adrenaline use in labor epidural analgesia, specifically if the concentration of fentanyl in maternal and fetal umbilical plasma was lowered with the use of adrenaline, if the maternal hemodynamics are affected by the use of epidural adrenaline, and finally if the use of programmed intermittent boluses are more efficacious than a continuous infusion in maintaining labor analgesia when adrenaline is used. These hypotheses were investigated in two randomized clinical trials.
We found lower plasma concentrations of fentanyl in maternal plasma during the first two hours of treatment, but no differences at delivery or differences in umbilical plasma.
We found no significant differences in maternal hemodynamics during the first 30 min of treatment.
We found no differences in treatment efficacy when comparing PIEB to CEI.
Overall, it is not possible to give a final conclusion on the use of adrenaline in labor epidural analgesia, but the data from our studies does not give grounds for a strong recommendation of its use in clinical practice.