Local anaesthetic nerve block for pain management in labour
Natalia Novikova, Catherine Cluver, Natalia Novikova, Catherine Cluver
Abstract
Background: Local anaesthetic nerve block is an important modality for pain management in labour. Pudendal and paracervical block (PCB) are most commonly performed local anaesthetic nerve blocks which have been used for decades.
Objectives: To establish the efficacy and safety of local anaesthetic nerve blocks for pain relief in labour.
Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012).
Selection criteria: We included randomised controlled trials (RCTs) assessing pain management in labour with the use of local anaesthetic nerve blocks. We did not include results from quasi-RCTs.
Data collection and analysis: We designed a form to extract data. For eligible studies, two review authors extracted the data using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. We entered and analysed data using Review Manager software and checked for accuracy.
Main results: We found 41 trials for consideration of inclusion into this review. We included only 12 RCTs (1549 participants) of unclear quality. We excluded 29 studies (30 reports). The majority of excluded studies were not relevant to this review, and a few were not randomised.Local anaesthetic nerve block versus placebo or no treatment. We found that more women were satisfied with pain relief after local anaesthetic nerve block (in particular 2% lidocaine PCB) than after placebo (one study, 198 participants, risk ratio (RR) 32.31, 95% confidence interval (CI) 10.60 to 98.54). Local anaesthetic nerve block was associated with more side effects (one study, 200 participants, RR 29.0, 95% CI 1.75 to 479.61).Local anaesthetic nerve block (in particular, PCB) versus opioid Local anaesthetic nerve block (in particular, PCB) in comparison with opioid (in particular, intramuscular pethidine or fentanyl patient-controlled analgesia) was found to be more effective for pain relief (one study, 109 participants, RR 2.52, 95% CI 1.65 to 3.83) and was not associated with an increased rate of assisted vaginal birth (two studies, 129 participants, RR 1.02, 95% CI 0.56 to 1.87) or with an increased caesarean section rate (two studies, 129 participants, RR 0.23, 95% CI 0.03 to 1.87).Local anaesthetic nerve block versus non-opioid agents 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 (one study, 100 participants, RR 1.11, 95% CI 0.67 to 1.84; RR 2.0, 95% CI 0.19 to 21.36, respectively). More women who received non-opioid agent in comparison with women who received local anaesthetic nerve block required additional interventions for pain relief (one study, 100 participants, RR 0.06, 95% CI 0.02 to 0.25).Local anaesthetic nerve block using different anaesthetic agents There was no difference in pain relief satisfaction, assisted vaginal birth, caesarean section, side effects for mother, Apgar score or admission to the neonatal intensive care unit between different anaesthetic agents, e.g. bupivacaine, carbocaine, lidocaine, chloroprocaine.
Authors' conclusions: Local anaesthetic nerve blocks are more effective than placebo, opioid and non-opioid analgesia for pain management in labour based on RCTs of unclear quality and limited numbers. Side effects are more common after local anaesthetic nerve blocks in comparison with placebo. Different local anaesthetic agents used for pain relief provide similar satisfaction with pain relief. Further high-quality studies are needed to confirm the findings, to assess other outcomes and to compare local anaesthetic nerve blocks with various modalities for pain relief in labour.
Conflict of interest statement
None known.
Figures
![1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-AFig-FIG01.jpg)
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![1.1. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-001-01.jpg)
![1.2. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-001-02.jpg)
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![2.4. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-002-04.jpg)
2.5. Analysis
Comparison 2 Local anaesthetic nerve…
2.5. Analysis
Comparison 2 Local anaesthetic nerve block versus opioids, Outcome 5 Number of women…
2.6. Analysis
Comparison 2 Local anaesthetic nerve…
2.6. Analysis
Comparison 2 Local anaesthetic nerve block versus opioids, Outcome 6 Mean time from…
3.1. Analysis
Comparison 3 Local anaesthetic nerve…
3.1. Analysis
Comparison 3 Local anaesthetic nerve block versus non‐opioid, Outcome 1 Satisfaction with pain…
3.2. Analysis
Comparison 3 Local anaesthetic nerve…
3.2. Analysis
Comparison 3 Local anaesthetic nerve block versus non‐opioid, Outcome 2 Caesarean section.
3.3. Analysis
Comparison 3 Local anaesthetic nerve…
3.3. Analysis
Comparison 3 Local anaesthetic nerve block versus non‐opioid, Outcome 3 Apgar score
3.4. Analysis
Comparison 3 Local anaesthetic nerve…
3.4. Analysis
Comparison 3 Local anaesthetic nerve block versus non‐opioid, Outcome 4 Number of women…
4.1. Analysis
Comparison 4 Local anaesthetic nerve…
4.1. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 1…
4.2. Analysis
Comparison 4 Local anaesthetic nerve…
4.2. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 2…
4.3. Analysis
Comparison 4 Local anaesthetic nerve…
4.3. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 3…
5.1. Analysis
Comparison 5 Local anaesthetic nerve…
5.1. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
5.2. Analysis
Comparison 5 Local anaesthetic nerve…
5.2. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
5.3. Analysis
Comparison 5 Local anaesthetic nerve…
5.3. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
6.1. Analysis
Comparison 6 Local anaesthetic block…
6.1. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 1 Assisted…
6.2. Analysis
Comparison 6 Local anaesthetic block…
6.2. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 2 Caesarean…
6.3. Analysis
Comparison 6 Local anaesthetic block…
6.3. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 3 Admission…
6.4. Analysis
Comparison 6 Local anaesthetic block…
6.4. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 4 Number…
- doi: 10.1002/14651858.CD009200
- Epidural versus non-epidural or no analgesia for pain management in labour.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Anim-Somuah M, et al. Cochrane Database Syst Rev. 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. Cochrane Database Syst Rev. 2018. PMID: 29781504 Free PMC article. Review.
- Non-opioid drugs for pain management in labour.Othman M, Jones L, Neilson JP. Othman M, et al. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD009223. doi: 10.1002/14651858.CD009223.pub2. Cochrane Database Syst Rev. 2012. PMID: 22786524 Review.
- Pain management for women in labour: an overview of systematic reviews.Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Jones L, et al. Cochrane Database Syst Rev. 2012 Mar 14;2012(3):CD009234. doi: 10.1002/14651858.CD009234.pub2. Cochrane Database Syst Rev. 2012. PMID: 22419342 Free PMC article. Review.
- Acupuncture or acupressure for pain management during labour.Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Smith CA, et al. Cochrane Database Syst Rev. 2020 Feb 7;2(2):CD009232. doi: 10.1002/14651858.CD009232.pub2. Cochrane Database Syst Rev. 2020. PMID: 32032444 Free PMC article.
- Relaxation techniques for pain management in labour.Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Smith CA, et al. Cochrane Database Syst Rev. 2018 Mar 28;3(3):CD009514. doi: 10.1002/14651858.CD009514.pub2. Cochrane Database Syst Rev. 2018. PMID: 29589650 Free PMC article. Review.
- Pain management strategies in urethral reconstruction: a narrative review.Chang C, Nikolavsky D, Ong M, Simhan J. Chang C, et al. Transl Androl Urol. 2022 Oct;11(10):1442-1451. doi: 10.21037/tau-22-363. Transl Androl Urol. 2022. PMID: 36386256 Free PMC article. Review.
- The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.Wang J, Zhao G, Song G, Liu J. Wang J, et al. J Pain Res. 2021 Jun 2;14:1559-1572. doi: 10.2147/JPR.S313972. eCollection 2021. J Pain Res. 2021. PMID: 34103981 Free PMC article.
- Parenteral opioids for maternal pain management in labour.Smith LA, Burns E, Cuthbert A. Smith LA, et al. Cochrane Database Syst Rev. 2018 Jun 5;6(6):CD007396. doi: 10.1002/14651858.CD007396.pub3. Cochrane Database Syst Rev. 2018. PMID: 29870574 Free PMC article. Review.
- Epidural versus non-epidural or no analgesia for pain management in labour.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Anim-Somuah M, et al. Cochrane Database Syst Rev. 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. Cochrane Database Syst Rev. 2018. PMID: 29781504 Free PMC article. Review.
- Immersion in water during labour and birth.Cluett ER, Burns E, Cuthbert A. Cluett ER, et al. Cochrane Database Syst Rev. 2018 May 16;5(5):CD000111. doi: 10.1002/14651858.CD000111.pub4. Cochrane Database Syst Rev. 2018. PMID: 29768662 Free PMC article. Review.
- Meta-Analysis
- Research Support, Non-U.S. Gov't
- Review
- Systematic Review
- Anesthesia, Obstetrical / methods*
- Anesthetics, Local*
- Female
- Fentanyl
- Humans
- Labor Pain / therapy*
- Meperidine
- Nerve Block / methods*
- Pain Management / methods
- Pregnancy
- Randomized Controlled Trials as Topic
- Anesthetics, Local
- Meperidine
- Fentanyl
- Full Text Sources
- Medical
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![2.5. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-002-05.jpg)
![2.6. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-002-06.jpg)
![3.1. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-003-01.jpg)
![3.2. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-003-02.jpg)
![3.3. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-003-03.jpg)
3.4. Analysis
Comparison 3 Local anaesthetic nerve…
3.4. Analysis
Comparison 3 Local anaesthetic nerve block versus non‐opioid, Outcome 4 Number of women…
4.1. Analysis
Comparison 4 Local anaesthetic nerve…
4.1. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 1…
4.2. Analysis
Comparison 4 Local anaesthetic nerve…
4.2. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 2…
4.3. Analysis
Comparison 4 Local anaesthetic nerve…
4.3. Analysis
Comparison 4 Local anaesthetic nerve block 1% lidocaine versus 2% chloroprocaine, Outcome 3…
5.1. Analysis
Comparison 5 Local anaesthetic nerve…
5.1. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
5.2. Analysis
Comparison 5 Local anaesthetic nerve…
5.2. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
5.3. Analysis
Comparison 5 Local anaesthetic nerve…
5.3. Analysis
Comparison 5 Local anaesthetic nerve block bupivacaine versus other local anaesthetic solution, Outcome…
6.1. Analysis
Comparison 6 Local anaesthetic block…
6.1. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 1 Assisted…
6.2. Analysis
Comparison 6 Local anaesthetic block…
6.2. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 2 Caesarean…
6.3. Analysis
Comparison 6 Local anaesthetic block…
6.3. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 3 Admission…
6.4. Analysis
Comparison 6 Local anaesthetic block…
6.4. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 4 Number…
- doi: 10.1002/14651858.CD009200
- Epidural versus non-epidural or no analgesia for pain management in labour.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Anim-Somuah M, et al. Cochrane Database Syst Rev. 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. Cochrane Database Syst Rev. 2018. PMID: 29781504 Free PMC article. Review.
- Non-opioid drugs for pain management in labour.Othman M, Jones L, Neilson JP. Othman M, et al. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD009223. doi: 10.1002/14651858.CD009223.pub2. Cochrane Database Syst Rev. 2012. PMID: 22786524 Review.
- Pain management for women in labour: an overview of systematic reviews.Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Jones L, et al. Cochrane Database Syst Rev. 2012 Mar 14;2012(3):CD009234. doi: 10.1002/14651858.CD009234.pub2. Cochrane Database Syst Rev. 2012. PMID: 22419342 Free PMC article. Review.
- Acupuncture or acupressure for pain management during labour.Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Smith CA, et al. Cochrane Database Syst Rev. 2020 Feb 7;2(2):CD009232. doi: 10.1002/14651858.CD009232.pub2. Cochrane Database Syst Rev. 2020. PMID: 32032444 Free PMC article.
- Relaxation techniques for pain management in labour.Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Smith CA, et al. Cochrane Database Syst Rev. 2018 Mar 28;3(3):CD009514. doi: 10.1002/14651858.CD009514.pub2. Cochrane Database Syst Rev. 2018. PMID: 29589650 Free PMC article. Review.
- Pain management strategies in urethral reconstruction: a narrative review.Chang C, Nikolavsky D, Ong M, Simhan J. Chang C, et al. Transl Androl Urol. 2022 Oct;11(10):1442-1451. doi: 10.21037/tau-22-363. Transl Androl Urol. 2022. PMID: 36386256 Free PMC article. Review.
- The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.Wang J, Zhao G, Song G, Liu J. Wang J, et al. J Pain Res. 2021 Jun 2;14:1559-1572. doi: 10.2147/JPR.S313972. eCollection 2021. J Pain Res. 2021. PMID: 34103981 Free PMC article.
- Parenteral opioids for maternal pain management in labour.Smith LA, Burns E, Cuthbert A. Smith LA, et al. Cochrane Database Syst Rev. 2018 Jun 5;6(6):CD007396. doi: 10.1002/14651858.CD007396.pub3. Cochrane Database Syst Rev. 2018. PMID: 29870574 Free PMC article. Review.
- Epidural versus non-epidural or no analgesia for pain management in labour.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Anim-Somuah M, et al. Cochrane Database Syst Rev. 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. Cochrane Database Syst Rev. 2018. PMID: 29781504 Free PMC article. Review.
- Immersion in water during labour and birth.Cluett ER, Burns E, Cuthbert A. Cluett ER, et al. Cochrane Database Syst Rev. 2018 May 16;5(5):CD000111. doi: 10.1002/14651858.CD000111.pub4. Cochrane Database Syst Rev. 2018. PMID: 29768662 Free PMC article. Review.
- Meta-Analysis
- Research Support, Non-U.S. Gov't
- Review
- Systematic Review
- Anesthesia, Obstetrical / methods*
- Anesthetics, Local*
- Female
- Fentanyl
- Humans
- Labor Pain / therapy*
- Meperidine
- Nerve Block / methods*
- Pain Management / methods
- Pregnancy
- Randomized Controlled Trials as Topic
- Anesthetics, Local
- Meperidine
- Fentanyl
- Full Text Sources
- Medical
![3.4. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-003-04.jpg)
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6.1. Analysis
Comparison 6 Local anaesthetic block…
6.1. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 1 Assisted…
6.2. Analysis
Comparison 6 Local anaesthetic block…
6.2. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 2 Caesarean…
6.3. Analysis
Comparison 6 Local anaesthetic block…
6.3. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 3 Admission…
6.4. Analysis
Comparison 6 Local anaesthetic block…
6.4. Analysis
Comparison 6 Local anaesthetic block with levobupivacaine versus racemic bupivacaine, Outcome 4 Number…
![6.1. Analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8966974/bin/nCD009200-CMP-006-01.jpg)
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Source: PubMed