Prophylactic Ephedrine and Combined Spinal Epidurals for Labor

Summary

The combined spinal epidural (CSE) technique has become increasingly popular for labor pain because of its rapid onset and superior first stage analgesia. However, increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern. Various factors are implicated in the etiology of EPFB but the cause is unknown. Ephedrine administration prior to CSE analgesia may help reduce the risk of EPFB, but to date, nobody has studied the impact of a single dose of intravenous (IV) ephedrine given at the time of CSE administration during labor. The purpose of this study is to measure the incidence of EPFB after combined spinal epidural analgesia using standard definitions. The incidence of EPFB will be compared between patients who receive prophylactic ephedrine or placebo at the time of CSE placement.

Timeline

Start

2012-01

Primary completion

2013-04

Completion

2013-10

Publications

• Background 1. Gambling DR et al.A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor. Anesthesiology 1998; 89: 1336-44. 2. Mardirosoff C et al. Fetal bradycardia due to intrathecal opioids for labour analgesia : a systematic review. BJOG 2002; 109: 274-81. 3.Wright RG et al: The effect of maternal administration of ephedrine on fetal heart rate and variability. Obstet Gynecol.1981; 57: 734-8. 4.Tong C, Eisenach JC: The vascular mechanism of ephedrine's beneficial effect on uterine perfusion during pregnancy. Anesthesiology 1992; 76: 792-8 5.Reidy J, Douglas J: Vasopressors in obstetrics. Anesthesiol Clin. 2008 ;26:75-88, vi- vii. Review. 6. Gambling DR, McLaughlin KR. Ephedrine and phenylephrine use during cesarean delivery. Anesthesiology 2010; 112: 1287-8. 7. Kreiser D et al. The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia. Obstet Gynecol. 2004;104:1277-81. 8. Cleary-Goldman J et al.. Prophylactic ephedrine and combined spinal epidural: maternal blood pressure and fetal heart rate patterns. Obstet Gynecol. 2005; 106: 466-72.
• Gambling DR, Bender M, Faron S, Glaser D, Farrell TR. Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study. Can J Anaesth. 2015 Nov;62(11):1201-8. doi: 10.1007/s12630-015-0450-8. Epub 2015 Aug 14.

Drugs

Indications

No indication recorded.