Does Ambulatory Epidural Analgesia Shorten Duration of Labor? Vallejo et al. (page 857)
Although ambulatory epidural analgesia reportedly adds to maternal comfort and aids labor, its ability to shorten the duration of labor has not been confirmed in a prospective, randomized trial. Vallejo et al. recruited 160 nulliparous women and randomly assigned them to one of two groups: epidural analgesia with or without ambulation. For purposes of the study, ambulation was defined as a minimum of 5 min of walking per hour. Patients in the nonambulatory group were confined to bed, with the angle of the head of the bed limited to 45° or less.
Epidural blocks were initiated with 15–25 ml ropivacaine, 0.07%, plus 100 μg/ml fentanyl. After adequate pain relief was achieved, patients received a continuous infusion of 0.07% ropivacaine plus 2 μg/ml fentanyl at 15–20 ml/h to maintain labor analgesia. Modified Bromage scores were obtained before and after epidural insertion and again at hourly intervals. After 1 h, patients in the ambulatory group were assessed in bed for motor function. Ambulation was encouraged if patients were able to stand on one foot and did not have hypotension. The research team recorded the time patients spent sitting or walking, the time interval from epidural insertion to complete cervical dilatation, and the time from epidural to the second stage of labor. The type of delivery (spontaneous, instrumental, vacuum, or cesarean) was also noted, as was each infant’s Apgar score at 1 and 5 min after delivery.
The authors found that patients in the ambulatory group walked 25.0 ± 23.3 min, sat upright 40.3 ± 29.7 min, or both. The time to complete cervical dilatation was 240.9 ± 146.1 min, compared with 211.9 ± 133.9 min in the nonambulatory group. Despite conventional wisdom that walking during labor facilitates delivery, these authors found that epidural analgesia with walking or sitting did not shorten the time from initiation of epidural anesthesia to complete cervical dilatation.