Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment in all studies and unclear blinding of outcome assessment in half of the studies).
A Cochrane overview [Abstract] 1 included 15 Cochrane reviews (255 included trials) and 3 non-Cochrane reviews (55 included trials) of pain management in labour, of which12 studies with a total of 1549 subjects deal with local anaesthetic nerve block. Satisfaction in pain relief was better with paracervical block (PCB) with 2% lidocaine versus PCB with distilled water (degree of pain relief rated as excellent/complete; RR 32.31, 95% CI 10.60 to 98.54; 1 trial, n=198). Adverse effects for women and infants (mother - giddiness, sweating, tingling of lower limbs; baby- bradycardia) were more common in lidocaine group. Women with PCB were more satisfied with pain relief compared with intramuscular pethidine (RR 2.52, 95% CI 1.65 to 3.83; 1 trial, n=109). There were no difference in instrumental vaginal deliveries or caesarean sections between PCB vs pethidine. There was no difference in pain satisfaction with PCB with 1% lidocaine versus 2% chloroprocaine; PCB with 0.25% bupivacaine versus 2% chloroprocaine or 1% carbacaine; or PCB with 1% lidocaine versus 2% chloroprocaine.
Another Cochrane review [Abstract] 2 included 12 trials involving a total of 1549 participants. Satisfaction with pain relief and rate of caesarean sections were found to be the same in women receiving local anaesthetic nerve block and non-opioid agents (RR 1.11, 95% CI 0.67 to 1.84; RR 2.0, 95% CI 0.19 to 21.36, respectively; 1 trial, n=100). More women who received non-opioid agent in comparison with women who received local anaesthetic nerve block required additional interventions for pain relief (RR 0.06, 95% CI 0.02 to 0.25).
Date of latest search:2019-09-13
Primary/Secondary Keywords