How does epidural analgesia compare with opioids for pain management during labor?

Abstract

When reviewers compare epidural analgesia with opioids for pain management in labor (primiparous or multiparous women in spontaneous labor with no complications), low‐certainty evidence suggests a significant reduction in pain during labor, greater satisfaction with pain relief (1000 vs 684 per 1000 women; all results on average), and higher rates of assisted vaginal birth (113 vs 79 per 1000 women) with epidural analgesia. Moderate‐certainty evidence shows similar rates of cesarean section and admission to the neonatal intensive care unit in both groups. As for adverse effects, hypotension, motor blockade, fever, and urinary retention were more common in women receiving an epidural, whereas respiratory depression requiring oxygen administration, nausea and vomiting, and neonatal acidosis and naloxone administration were more frequent in those given opioids; most trials reported low event rates in both groups.