Nitrous Oxide Versus Epidural for Pain Management During Labor and Delivery [32K]

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Abstract

INTRODUCTION:

Expansion of analgesic options is a strong interest of obstetric providers and patients. Epidural leaves women bed-bound; hence, many women desire a less-extreme option, like nitrous oxide (N2O). This study's purpose was to directly compare and determine whether patients preferred N2O to epidural during labor and delivery.

METHODS:

This IRB-approved prospective study included women who gave birth at Mount Sinai West's Labor and Delivery Unit between January 2017 and March 2017. All women who started their labor course using either N2O or epidural, and did not deliver by cesarean section, were asked to complete an anonymous questionnaire after delivery and before discharge. The questionnaire explored subjective experience with analgesia, using yes-no or 1–10 scale answers.

RESULTS:

47 women were included; 29 received epidural as their initial analgesia, while 18 started with N2O. There were no demographic differences between these two groups. Women in the epidural group experienced significantly less pain (3 [2–5] versus 8 [7–9], P<.001); were more likely to complete their delivery using their first analgesic method (29/29 [100%] versus 5/18 [27.8%], P<.001); were more satisfied with their labor and delivery experience (9 [8–10] versus 6 [4–9], P=.002) and stated they were more likely to use their pain relief method again (27/29 [93%] versus 11/18 [61%], P=.018).

CONCLUSION:

This is the first direct comparison of epidural and nitrous oxide. There was a clear preference for epidural. However, responses from women desiring a “natural” birth should be identified and compared. Further research is also needed to study nitrous oxide as a bridge for pain control before receiving an epidural.

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