Influence de l’anesthésie péridurale sur la durée et les modalités de l’accouchement

Abstract

du taux des dystocies. © 2001 Éditions scientifiques et médicales Elsevier SAS anesthésie péridurale / bupivacaïne / césarienne / dystocie / extraction instrumentale / rachianalgésie ropivacaïne ABSTRACT Effect of epidural analgesia on labour and delivery. Objective: To determine the effect of epidural analgesia (EA) on the duration of labour and the mode of delivery. Data sources:AMedline computerised literature research was conducted from 1989 to 2000 including all the prospec- tive studies comparing EA and systemic analgesia during labour. Data synthesis: EA prolongs the first and second stages of labour and increases the rate of instrumental delivery, without neonatal side effects. EAis not responsible for dys- tocia and caesarean section rate is not increased by this mode of analgesia. The effect of combined spinal-epidural analgesia is comparable to the one of EA on the length of labour and the mode of delivery. Ropivacaine does not appear to be different from bupivacaine in that setting. The benefit of ambulation remains controversial since it does not reduce the incidence of instrumental delivery,compared to conventional EA with similarly diluted local anaesthetic solutions. Conclusions: Pain relief provided byEAcombined to modi- fication of obstetric management (amniotomy, oxytocin) does not impair the rate of caesarean section and dysto- cia.