Meta-analysis On Influence Of Persistent Epidural Nerve Block Anesthesia On The Outcome Of Analgesia

Objective:Meta-analysis was used to compare the obstetric outcomes of the maternal analgesia group with continuous epidural anesthesia and the control group with non-delivery analgesia.To investigate the effects of continuous epidural block anesthesia on maternal and fetal outcomes by comparing the labor time,postpartum hemorrhage,neonatal Apgar score,and the mode of delivery of two groups,thus providing a targeted reference for the development and promotion of labor analgesia.Methods:The computer was used to search the Web of Science Database Core Collection(SCIE),China Knowledge Network Database(CNKI)and Wanfang Database.The search period was limited to April 30,2019,and the keywords were used for retrieval.The study outcomes included labor time,postpartum hemorrhage,neonatal Apgar score,and mode of delivery.The interventions included continuous epidural block analgesia,and the control group without labor analgesia.For the final inclusion of the literatures,the relevant data had been read again.The two researchers was collectted data from the literatures separately,compared the collected data,and re-check the non-conforming data.After completion,Excel 2016 was used for data entry,and statistical analysis was performed on the collected data using Stata12.0.Results:Chinese(epidural anesthesia OR labor analgesia)AND(pregnancy outcome OR maternal and child outcomes)as a search strategy,foreign language(Epidural anesthesia OR labor anesthesia)AND(obstetric outcome OR labor OR pregnan*)as a retrieval strategy.A total of 2,299 articles were retrieved from the SCIE,CNKI,and Wanfang Database.A total of 27 articles that met the collection criteria of the study were included.The total sample size of the selected articles was 103,394.1.There was no significant difference in the first stage of labor time between the labor analgesia group and the control group [SMD=-0.334,95% CI(-0.670,0.003),Z= 1.94,P=0.052>0.05].There was no significant difference in the duration of the first stage of labor [SMD=-0.45,95% CI(-0.97,0.07),Z= 1.68,P=0.093>0.05],and the difference in the second stage of labor was not statistically significant [SMD =0.12,95% CI(-0.07,0.32),Z= 1.28,P=0.201>0.05],the difference in the third stage of labor was not statistically significant [SMD=0.00,95% CI(-0.18,0.19),Z = 0.01,P = 0.991 > 0.05].2.There was no significant difference in postpartum hemorrhage between the labor analgesia group and the control group(RR=1.01,95% CI(0.80,1.29),Z=0.12,P=0.907>0.05].There was no significant difference in postpartum hemorrhage between the labor analgesia group and the control group(continuous data)[SMD=0.06,95% CI(-0.20,0.32),Z = 0.44,P=0.659>0.05].3.There was no significant difference in neonatal asphyxia rate between 1 minute Apgar score in neonatal labor analgesia group [RR=1.17,95% CI(0.80,1.70),Z==0.79,P=0.429>0.05].The Apgar score of neonates in the labor analgesia group was lower than that of the control group [SMD=-0.14,95% CI(-0.24,-0.03),Z=2.54,P=0.011<0.05].4.There was no significant difference in the yield of labor force between the labor analgesia group and thecontrol group [RR=1.25,95% CI(0.94,1.66),Z=1.56,P=0.118>0.05].The cesarean section rate in the labor analgesia group was lower than that in the control group [RR=0.67,95% CI(0.55,0.83),Z=3.73,P<0.05].Conclusions:1.Continuous epidural block anesthesia would not prolong the first stage of labor,the second stage of labor,and the third stage of labor.2.Continuous epidural block anesthesia during labor would not increase postpartum hemorrhage.3.Continuous epidural block anesthesia during labor could reduce the neonatal 1 minute Apgar score,but does not increase neonatal asphyxia.4.Continuous epidural block anesthesia during labor could reduce the rate of cesarean section without increasing the productivity of the forceps.