Perinatal outcomes after regional analgesia during labour.

BACKGROUND: Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes. AIMS: To examine the association between regional analgesia and maternal and neonatal outcomes. MATERIALS AND METHODS: A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used. RESULTS: There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52-3.67), caesarean section (aOR = 2.30, 95% CI: 2.24-2.35), longer duration of the second stage of labour (ß coefficient = 26.6 min, 95% CI: 26.3-27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21-1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40-1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65-1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56-1.62). CONCLUSION: Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk-benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.

Transcutaneous electrical nerve stimulation with the injection of pethidine and promethazine in the labor pain reduction: A randomized controlled trial.

Background: The use of transcutaneous electrical nerve stimulation (TENS) to relieve labor pain remains controversial and existing evidence is neither strong nor consistent. This research was designed to compare TENS' effect with the injection of pethidine and promethazine in labor pain reduction. Methods: In this trial, for 45 pregnant women in the active phase of labor, TENS electrodes were placed (two on both arms, and two over the participants' low back) continuously for 120 minutes; and for another group 45 pregnant women, 100 milligrams of pethidine and 250 micrograms of promethazine were injected intramuscularly which could be repeated once at least one hour later. Labor pain and duration, need for labor induction/augmentation/other pain control methods/ instrumental delivery, delivery type, and maternal and newborn complications were measured in both groups. Results: The baseline mean visual analog scale (VAS) score, in the TENS group was 8.51±0.62 and in the pethidine and promethazine groups was 8.37±0.61 (P=0.31). While in a 120min post-intervention, it was 6.29±1.50 and 5.73±1.46 in the TENS group and the pethidine and promethazine group, respectively with no statistically significant difference (P=0.07). The labor duration in the TENS group was 6.61±1.71 hours and in the pethidine and promethazine group was 6.17±2.07 hours, with no statistically significant difference (P=0.33). In addition, no complication was recorded neither in the mothers nor newborns. Conclusion: This study showed that applying TENS in the active labor phase can reduce at least two scores in patient labor pain with no significant complications.

Effect of programmed intermittent epidural bolus protocol on physician-administered rescue boluses of labor analgesia.

Background: Prior studies have shown that programmed intermittent epidural bolus (PIEB) techniques, with or without patient-controlled epidural analgesia (PCEA) boluses, provide better pain relief, reduced motor block, and better patient satisfaction compared to continuous epidural infusion (CEI) techniques. We hypothesized that patients who had labor epidural analgesia (LEA) maintained with PIEB and PCEA would be less likely to receive a physician-administered rescue analgesia bolus compared to patients who had CEI and PCEA. Methods: We searched our electronic medical record for patients who had CEI and PCEA from August 1, 2021 to December 31, 2021 and for patients who had PIEB and PCEA from August 2, 2022 to December 31, 2022. Results: A total of 792 and 665 patients had maintenance of LEA with CEI/PCEA and PIEB/PCEA, respectively. A multivariate logistic regression was performed and, after adjusting for variables of interest, patients who had PIEB and PCEA were less likely to receive one or more physician-administered rescue analgesia boluses (odds ratio 0.504; 95% confidence interval 0.392, 0.649; P < 0.001) compared to patients who had CEI and PCEA. Conclusion: PIEB/PCEA was associated with fewer physician-administered boluses of rescue analgesia compared to CEI/PCEA when used for LEA.

Antepartum depressive symptoms are associated with significant postpartum opioid use.

BACKGROUND: Antepartum depression is common, and outside of childbirth preoperative anxiety and depression have been associated with heightened postoperative pain. In light of the national opioid epidemic, the relationship between antepartum depressive symptoms and postpartum opioid use is particularly relevant. OBJECTIVE: This study evaluated the association between antepartum depressive symptoms and significant postpartum opioid use during birth hospitalization. STUDY DESIGN: This retrospective cohort study at an urban academic medical center from 2017 to 2019 included patients who received prenatal care at the medical center and linked pharmacy and billing data with electronic medical records. The exposure was antepartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale ≥10 during the antepartum period. The outcome was significant opioid use, defined as: (1) any opioid use following vaginal birth and (2) the top quartile of total opioid use following cesarean delivery. Postpartum opioid use was quantified using standard conversions for opioids dispensed on postpartum days 1 to 4 to calculate morphine milligram equivalents. Poisson regression was used to calculate risk ratios and 95% confidence intervals, stratified by mode of delivery and adjusted for suspected confounders. Mean postpartum pain score was a secondary outcome. RESULTS: The cohort included 6094 births; 2351 births (38.6%) had an antepartum Edinburgh Postnatal Depression Scale score. Of these, 11.5% had a maximum score ≥10. Significant opioid use was observed in 10.6% of births. We found that individuals with antepartum depressive symptoms were more likely to have significant postpartum opioid use, with an adjusted risk ratio of 1.5 (95% confidence interval, 1.1-2.0). When stratified by mode of delivery, this association was more pronounced for cesarean births, with an adjusted risk ratio of 1.8 (95% confidence interval, 1.1-2.7), and was no longer significant for vaginal births. Mean pain scores after cesarean delivery were significantly higher in parturients with antepartum depressive symptoms. CONCLUSION: Antepartum depressive symptoms were associated with significant postpartum inpatient opioid use, especially following cesarean delivery. Whether identifying and treating depressive symptoms in pregnancy may impact the pain experience and opioid use postpartum warrants further investigation.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report.

Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis.

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (-7.60 (-12.49, -2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia.

Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial / Evaluación de la duración de la analgesia obstétrica y del tiempo entre la analgesia y el parto. Estudio observacional

Abstract Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay. Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers. Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique. Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n=114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used - 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27). Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.

Resumen Introducción: La duración del trabajo de parto y del puerperio inmediato se afectan por factores obstétricos y maternofetales. Las intervenciones para brindar analgesia obstétrica pudieran prolongar el tiempo total de estancia hospitalaria. Objetivo: Caracterizar el procedimiento de analgesia obstétrica y describir los tiempos entre analgesia y parto y vigilancia posparto en maternas sanas. Métodos: Estudio descriptivo observacional. Se midieron los tiempos entre analgesia y parto y vigilancia posparto en gestantes sanas, cuya vía final del parto fuera vaginal con indicación y aplicación de alguna técnica de analgesia neuroaxial. Resultados: Se incluyeron 226 pacientes. La mediana del tiempo de analgesia hasta el parto fue de 4 horas (RIC 3-7); el 50,7 % (n = 114) recibió analgesia temprana (técnica neuroaxial a ≤ 4 centímetros de dilatación cervical), de las cuales el 48,2 % (n = 109) tuvo un tiempo de analgesia hasta el parto mayor al esperado. La mediana de dilatación cervical al momento del abordaje del neuroeje fue de 4 centímetros (RIC 4-6) y la técnica epidural fue la más frecuente, 92,9 % (n = 210). La mediana de tiempo de vigilancia posparto fue de 20 horas (RIC 15-27). Conclusiones: La mitad de las pacientes incluidas recibió analgesia temprana y cerca de la mitad tardó más de lo esperado en finalizar su gestación. El tiempo de vigilancia posparto fue acorde con lo establecido por el Ministerio de Salud y con la tendencia actual de una vigilancia posparto corta que apunte a un alta temprana y sus beneficios.

Neuraxial labor analgesia is associated with a reduced risk of postpartum depression: A multicenter prospective cohort study with propensity score matching.

BACKGROUND: Depression is a common and serious complication in new mothers. We investigated the hypothesis that neuraxial labor analgesia is associated with a decreased risk of postpartum depression. METHODS: In this multicenter prospective cohort study with propensity score matching, 599 nulliparous women with single term cephalic pregnancy who planned vaginal delivery were enrolled and self-selected neuraxial analgesia or not. The primary outcome was 6-week postpartum depression assessed with the Chinese version Edinburgh Postnatal Depression Scale; a score of ≥10 was set as the threshold of postpartum depression. Logistic regression models were established to assess the association between neuraxial labor analgesia and postpartum depression. RESULTS: Of the 577 parturients who completed the study, 417 (72.3%) received neuraxial analgesia and 160 (27.7%) did not. After propensity score matching, 433 parturients were included in the analysis; of whom, 279 (64.4%) received neuraxial analgesia and 154 (35.6%) did not. The incidence of postpartum depression was lower in parturients with neuraxial analgesia than in those without (14.9% [62/417] vs. 23.8% [38/160], P=0.012 before matching; 13.3% [37/279] vs. 23.4% [36/154], P=0.007 after matching). After adjustment for confounding factors, neuraxial analgesia was associated with decreased odds of postpartum depression (odds ratio [OR] 0.50, 95% CI 0.28-0.88, P=0.015 before matching; OR 0.40, 95% CI 0.21-0.77, P=0.006 after matching). LIMITATIONS: As an observational study, unidentified confounders might influence the results. CONCLUSIONS: In nulliparae with single term cephalic pregnancy preparing to give vaginal delivery neuraxial analgesia during labor was associated with a decreased risk of 6-week postpartum depression.

Comparing Bupivacaine, Lidocaine, and a Combination of Bupivacaine and Lidocaine for Labor Epidural Activation: A Prospective, Randomized, Double-Blind Study

Objective: Epidural anesthesia for the parturient is often provided in a clinical context where rapid onset of segmental analgesia is important; however, little is published on the ideal local anesthetic to safely achieve this onset. To fi ll this gap in knowledge, we studied bupivacaine and lidocaine, two local anesthetics (LA) commonly used for labor epidural activation, either as a single drug or in combination to determine the onset of epidural analgesia. Methods: In this double-blinded study, seventy-five patients were randomized into three groups (n = 25 each) for labor epidural activation: 10 mL of 0.25% bupivacaine, 10 mL of 1% lidocaine, or 5 mL of 0.25% bupivacaine plus 5 mL of 1% lidocaine. Patients were assessed for the fi rst 20 min after drug administration at 5-min intervals. Data collected included sensory level to pinprick, maternal blood pressure, vasopressor administration, and peak motor blockade. Results: Data were analyzed on 71 of 75 patients. Time to loss of sensation to pinprick at the T10 dermatome in the bupivacaine group was signifi cantly longer than the lidocaine group (p = 0.006), but the time to loss of sensation to pinprick at the T10 dermatome did not signifi cantly differ in the bupivacaine plus lidocaine group when compared to both the bupivacaine (p = 0.114) as well as the lidocaine (p = 0.203) groups. Phenylephrine usage did not signifi cantly differ amongst the three groups (p = 0.062). Conclusion: Lidocaine provides statistically signifi cant faster onset of epidural analgesia when compared to bupivacaine only. Combining the two LA did not signifi cantly affect onset.

Modern techniques to optimize neuraxial labor analgesia

Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patient-controlled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.

Intravenous Remifentanil Analgaesia for an Obstetric Patient with Type I Neurofibromatosis and a Factor V Leiden Mutation.

Type I neurofibromatosis is characterised by altered skin pigmentation and the growth of benign tumours, particularly along the peripheral nerves and central nervous system. We report a 36-year-old primigravida woman in labour who was admitted to the obstetric suite of the Hospital Sant Joan de Déu, Barcelona, Spain, in 2007 with hypothyroidism, type I neurofibromatosis and a factor V Leiden mutation. Due to a lack of cranial and spinal imaging data, an epidural was not indicated; instead, continuous intravenous remifentanil analgaesia was administered. The remifentanil infusion was self-titrated by the patient using a visual analogue scale, with the dosage ranging from 0.01 to 0.25 µg/kg/minute. Due to rotational dystocia, Kjelland-type forceps were used during the delivery. After birth, the infant was found to have Apgar scores of 9 and 10, with no maternal or neonatal adverse effects observed. Although still controversial, remifentanil may be a successful alternative for analgaesia in similar cases; however, the specific risks and benefits for each patient should be considered prior to administration.

Caracterización del dolor perineal postparto en puérperas / Characteristics of perineal pain postpartum in women

Introducción: El dolor perineal posparto es un problema clínico frecuente, no abordado en profundidad en Colombia. Objetivo: Determinar la prevalencia, severidad y posibles factores asociados con el dolor perineal postparto en una muestra de mujeres en el Hospital La Victoria-Instituto Materno Infantil de Bogotá. Materiales y métodos: Estudio observacional prospectivo. Se evaluó el grado de dolor perineal percibido en 133 pacientes en posparto, mediante la escala análoga numérica de dolor, estando acostada, sentada, caminando y yendo al baño (micción y/o defecación), a las 12 y 48 horas postparto. Datos demográficos, del parto y recién nacido fueron tomados directamente de las historias clínicas. Resultados: Prevalencia global del dolor perineal moderado a severo 36-39,5% dependiendo de la actividad a las 12 horas del parto y entre 28-31,6% a las 48 horas. El dolor perineal se encontró asociado, en cualquiera de las actividades valoradas, con el uso de analgesia epidural durante el trabajo de parto, desgarro grado II o mayor, peso y perímetro cefálico del recién nacido. Se registra mejor efecto analgésico con dosis de acetaminofén de 3 g diarios o más. Conclusiones: El dolor perineal moderado a severo afecta a menos del 50% de las mujeres postparto vaginal; se asocia con la frecuencia y magnitud del trauma perineal. Los resultados sugieren la necesidad de profundizar en el estudio del manejo analgésico más adecuado para estas pacientes.

Introduction: Postpartum perineum pain is a common clinical problem, which is not addressed in detail in Colombia. Objective: To assess prevalence, magnitude and possible factors associated with postpartum perineum pain in a sample of women in the Hospital "La Victoria-Instituto Materno Infantil", in Bogotá. Materials and methods: A prospective observational study was performed where the degree of perineum pain perceived by 133 postpartum patients was evaluated by using numerical analog scale of pain when they were sitting down, lying, walking and going to the bathroom (urination and/or defecation), at 12 and 48 hours of postpartum . Demographic, birth and newborn data were taken directly from the medical records. Results: Overall prevalence of moderate to severe perineum pain 36 to 39.5% depending on the activity at 12 hours of delivery, and since 28 to 31.6% at 48 hours after it. Perineum pain was associated, during any of the activities assessed, with the use of epidural analgesia during labor, laceration of degree II or greater, birth weight and head circumference of the newborn. Better analgesic effect of acetaminophen doses as 3 g per day or more was registered. Conclusions: Moderate to severe perineum pain affects less than 50 % of women with vaginal postpartum. It is associated with the frequency and degree of perineum trauma. The results suggest the need for further study of the most appropriate analgesic doses for these patients.

Double blind comparison of combination of 0.1% ropivacaine and fentanyl to combination of 0.1% bupivacaine and fentanyl for extradural analgesia in labour.

BACKGROUND AND AIMS: Ropivacaine is considered as a safe alternative to bupivacaine for labor analgesia. The aim was to compare epidural ropivacaine and bupivacaine in intermittent doses for obstetric analgesia. MATERIAL AND METHODS: In this prospective, randomized, double-blind study, 60 women in labor were randomly allocated to receive either bupivacaine 0.1% with fentanyl 2 µg/mL (BF), or ropivacaine 0.1% with fentanyl 2 µg/mL (RF). Bromage scale, loss of cold sensation to ether swab in midclavicular line, visual analog scale were used to test for motor block, sensory block and pain, respectively. Hemodynamic parameters, onset of analgesia, dose requirement of drug to produce analgesia, duration of labor, and incidence of side effects were also recorded. Data were expressed as mean ± standard deviation and analyzed using students unpaired t-test, Chi-square and Mann-Whitney U-tests at P < 0.05. RESULTS: Both drugs were similar with respect to hemodynamic stability, onset of analgesia, quality of analgesia, sensory blockade, neonatal outcome, requirement of drugs, duration of labor, and incidence of side effects. Three parturient in bupivacaine (B-F) group had a motor block of Bromage 1 and were delivered using forceps. None of the parturient in ropivacaine (R-F) group had any motor block, and all had spontaneous vaginal delivery, but this difference was not statistically significant (P = 0.081). CONCLUSIONS: Bupivacaine and ropivacaine provide equivalent analgesia in low (0.1%) concentration.

Analgesia del parto en adolescentes: resultados de nuestra experiencia desarrollada en el Hospital de la Mujer – Centro Hospitalario Pereira Rossell / Adolescent use of analgesia for delivery: results of an experience at the Women´s Hospital - Pereira Rossell Hospital Center

Introducción: el embarazo adolescente constituye un impacto biopsicosocial. La analgesia obstétrica mejora la satisfacción materna y el vínculo madre-hijo. Objetivo: describir las embarazadas adolescentes que recibieron analgesia epidural y la eficacia de la misma, para conocer la realidad de estas pacientes y el trabajo que realizamos en el Hospital de la Mujer. Material y método: estudio retrospectivo, descriptivo, de enero de 2012 a enero de 2013. Revisamos 186 historias registrando: edad, paridad, escala verbal análoga (EVA) previo a la analgesia y a los 10 minutos, duración, parto o cesárea, complicaciones maternas, test de satisfacción, Apgar. Resultados: el promedio de edad fue de 17,3 ? 0,1 años. El 85,5% eran primigestas; 9,7% secundigestas, y 1,1% tercigestas. El 80,1% presentaban EVA de 10; 5,9% EVA de 9; 8,6% EVA de 8. A los 10 minutos, el 97,3% presentaban EVA de 0 y el 4,8% un EVA entre 1 y 4. Se encontró una diferencia estadísticamente significativa entre el EVA al inicio y a los 10 minutos en 179 pacientes, valor p < 0,001. El 67,2% estuvieron totalmente calmadas y el 32,8% parcialmente calmadas. La duración de la analgesia presentó un promedio de 198,9 ± 8,1 minutos. El 84,9% tuvo parto y el 15,1% cesárea. No existieron complicaciones maternas graves. El 98,4% de los neonatos fueron vigorosos. Conclusiones: la mayoría de las adolescentes estaban en etapa tardía, eran primigestas y presentaban dolor severo. La analgesia del parto representó una técnica eficaz. Se requieren más estudios para evaluar el impacto sobre la vía de finalización del parto...

Dexmedetomidina como coadyuvante analgésico para el trabajo de parto. Reporte de dos casos / Dexmedetomidine as adjunct for analgesia in labor. A report of two cases

Actualmente el remifentanil es el medicamento de elección en las pacientes candidatas para analgesia intravenosa durante el trabajo de parto; sin embargo, en algunas parturientas no se consigue un adecuado control del dolor con el uso de este opioide. El presente artículo resume dos casos donde la dexmedetomidina se utiliza como coadyuvante en la analgesia intravenosa con remifentanil, con buenos resultados.

At present, remifentanil is the first choice in obstetrical patients who are candidates for intravenous analgesia during labor, although in some cases, the use of this opioid does not provide adequate pain control. This article summarizes two cases where dexmedetomidine was used successfully as an analgesic adjunct to intravenous remifentanil during labor.

Epidural neostigmine for labor pain: A meta-analysis / 第二军医大学学报

Objective To evaluate the efficacy and safety of epidural neostigmine in management of labor pain. Methods Randomized controlled trials (RCTs) about epidural neostigmine combined with local anesthetics or opioids (experimental group) versus local anesthetics or opioids alone (control group) in management of labor pain were retrieved from Cochrane Library, PubMed, EMbase, Wanfang Database, CNKI, and CBMdisc from the date of their establishment to September 2011. The methodological quality of included RCTs was evaluated by two reviewers independently, and meta-analysis was conducted with the included RCTs using RevMan 5. 1. 4 software. Continuous variables were dealt with mean difference and 95% confidence interval(CI), and the dichotomous variables were dealt with odd ratio and 95% CI. Results We identified 4 RCTs including 282 patients. The results of meta-analyses showed that the values of visual analogue scale (VAS) were significantly lower in the experimental group compared with the control group[low dose(l-2 μg/kg or 250 μg): MD= - 1. 45, 95%CI(-2. 84,-0. 07), P=0. 04; median dose(4 μg/kg or 500 μg): MD=-2. 35, 95%CI (-3. 69, -1.02), P = 0. 000 6; high dose(6-7 μg/kg or 750 μg): MD= -21,95%CI(36. 31,-5. 69),P = 0. 007]. The adverse reactions such as nausea and vomiting were not significantly different between the two groups. Moreover, epidural neostigmine seemed to have no influence on the total duration of labor or the mode of delivery (cesarean section rate or instrumental delivery rate). Apgar scores of the neonates were similar in the two groups. Conclusion The results of our analysis show that epidural neostigmine combined with local anesthetics or opioids has a stronger analgesic effect in managing labor pain whithout increasing the incidence of adverse events.