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OBSTETRIC ANESTHESIA

The Effects of Prolonged Ambulation on Labor with Epidural Analgesia

Stéphane Frenea, MD^*, Christine Chirossel, MD^*, Raphaël Rodriguez, Jean-Philippe Baguet, MD, PhD, Claude Racinet, MD, and Jean-Francois Payen, MD, PhD^* Section Editor

*Department of Anesthesiology, Department of Obstetrics, and Department of Cardiology and Hypertension, Albert Michallon Hospital, Grenoble, France

Address correspondence and reprint requests to Jean-Francois Payen, Département d’Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, 38043 Grenoble, France. Address e-mail to jfpayen{at}ujf-grenoble.fr

Ambulation during labor is becoming more popular, although its impact on the progress of labor and on pain intensity remains unclear. We wondered whether prolonged ambulation with epidural analgesia had a possible effect on duration of labor and pain. In this prospective, randomized trial, 61 parturients with uncomplicated term pregnancies were allocated to be recumbent (n = 31) or to ambulate (n = 30). Epidural analgesia was provided with intermittent administrations of 0.08% bupivacaine-epinephrine plus 1 µg/mL of sufentanil. Of the 30 women assigned to the ambulatory group, 25 actually walked. Their ambulating time was 64 ± 34 min (mean ± SD), i.e., 29% ± 16% of the first stage. There were no differences between the two groups in the length of labor and in pain visual analog scale scores. However, the ambulatory group received smaller doses of bupivacaine (6.4 ± 2.2 mg/h versus 8.4 ± 3.6 mg/h; P = 0.01) and of oxytocin (6.0 ± 3.7 mUI/min versus 10.2 ± 8.8 mUI/min; P < 0.05). A greater ability to void was also found in the ambulatory group (P < 0.01). Although the duration of labor and pain relief was unchanged, these findings support that ambulation during labor may be advantageous.

IMPLICATIONS: This study compared the duration of labor and pain relief between parturients receiving epidural analgesia who were ambulated or were recumbent. Whereas walking had no impact on either duration of labor or pain relief, it was associated with a reduction in both bupivacaine and oxytocin requirements.

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