Oleh : Ferdi Pembimbing : Dr. H. Zulkifli, Sp.An, M.

Kes

Child birth is most paintful experiences a woman can under go

This experience may have long-term and psychological effects

The neuroaxial analgesia has surpassed The current standart labor epidural analgesic regimens consist

Patient Satisfaction ts

IEB compare d CEI

The need for manual anesthesia intervension

Labor progessio n

Mode of delivery

 MEDLINE, CENTRAL,EMBASE Information Original authors were sources contact and asked for and search any clarification of strategy primary outcome measures

Study Identification
All Publish RCTs comparing IEB and CEI
Healthy laboring women (nullipara & Para) With lumbar epidural catheter placed Primary outcome: patient satisfaction, anesthesia intervension & mode of delivery Secondary: motor blockade, degree of sensory blockade n side effect

 Data extract by 2 authors Data presented as medians,range and CI, the mean and standart deviation were calculated AP < 0.1was considered statisically significant heterogenity I2 > 50% was considered to indicate significant heterogenity

RESULTS
21 articles were selected for in depth full text article 9 articles were deemed eligible for inclusion 12 articles were exclude 344 subject received CEI 350 subject received IEB

Mode of Delivery

8 reported data on the mode of delivery

Studies included 652 subject

None of this studies reported a significant difference in the CD rate

 There was no statistically significant different in total duration of labor between IEB and CEI the duration in second stage of labor was statistically significantly shortened in IEB group

 Sia et al., reported no significant difference in the pain-free interval between CEI and IEB. Wong et al., did report the time to first PCEA usage, and this was not significantly different between the IEB and CEI groups.

3 published data regarding the total dose of local anesthesia 5 studies reported the total dose given
There was a statically significant reduction in total local anesthesia with IEB
There was no publication bias for local anesthetic consumption

4 studies reported with VRS with 0 dissatisfied & 100 is extremely satisfied

Wong et al reported satisfaction with VAS score

There was no publication bias for maternal satisfaction

Subgroup Analysis of Primary Outcomes

Outcome base on 1. the use of CSE to initiate labor analgesia 2. the use of PCEA during maintenance of labor analgesia

CSE did not have significant effect on any primary outcomes

PCEA

Secondary: motor blockade, degree of sensory blockade n side effect

Healthy laboring women (nullipara & Para)

All Publish RCTs comparing IEB and CEI

Additiona l outcomes

Primary outcome: patient satisfaction, anesthesia intervension & mode of delivery

With lumbar epidural catheter placed

Discussion
21 9 articles articles were were selected deemed for in eligible depth for full text inclusion article 12 articles were exclude 344 subject received CEI 350 subject received IEB

9 high-quality low risk bias of RCTs

Evaluate IEB and CEI in labouring women

Mode of delivery Intermittent bolus No significant effect Reduced local consumption Reduce d Labour time Reduce d dose

Mode of maintenance

Studies

Small sample

Should be interpreted with caution

Instrument delivery rate

Duration of delivery

Improvement of Maternal satisfaction

IEB Reduced local anesthetic consumption Shorter second stage of labour Higher maternal satisfaction

CEI Higher dose required Longer first stage of labour Lower maternal satisfaction

Terima Kasih