Complications of epidural and combined spinal-epidural analgesia in labour

The practice of relieving pain during childbirth with epidural or combined spinal-epidural analgesia is very widespread in the major Western countries, and is increasing in Italy. There are, however, numerous complications of this practice for both the woman and the mechanism of the labour. The aim of our study was to evaluate the short and long term complications of these techniques in a randomised sample of women.

A randomised, longitudinal, retrospective study was carried out in a sample of caucasian nulliparous women who gave birth in the second half of 2001. The subjects were divided into 3 groups: Group 1, women who gave birth with the aid of epidural analgesia; Group 2, women who received combined spinal-epidural analgesia during labour; Group 3, women who delivered without any analgesia. The short and long term complications of the 2 analgesic techniques were compared with those occurring in the control group, using Fisher's exact test.

The frequency of at least one unwanted effect was higher in the 2 groups of women who received analgesia than in the control group. Hypotension and pruritus were statistically significantly more frequent in the group receiving spinal-epidural analgesia than in the other 2 groups. There were no statistically significant differences between the 3 groups in the rates of late complications or incidence of deliveries completed by cesarean section.

The short-term complications of the analgesic techniques used during labour were not very relevant with respect to the subjects' satisfaction (excellent in 66% of the women in the group managed with epidural analgesia and 73% among those treated with the combined spinal-epidural technique). There was not a statistically significant difference in the percentage of cesarean deliveries in the 3 groups. Epidural and spinal-epidural analgesia to relieve pain during labour can, therefore, be considered safe and reliable.