The effect of epidural analgesia for labor on maternal temperature_West China Medical Journal

Authors：

LIN Yuangui ,  LUO Linli

Department of Anesthesiology, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LUO Linli, Email: linli-luo@163.com

Keywords：

Epidural analgesia for labor; Fever; Heat shock protein

DOI：

10.7507/1002-0179.201701100

Video：

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Objective To explore the effect of epidural analgesia for labor on maternal temperature and the newborns. Methods This randomized trial was performed in West China Second Hospital between December 2015 and July 2016. Fifty puerperants were randomly divided into epidural analgesia (EA) group (natural labor under EA, n=25) or the control group (natural labor using Ramaze breathing method, n=25). Maternal tympanic temperature was recorded once per hour after treating with painless labor or blank control. The serum interleukin-1 beta (IL-1β) and heat shock protein 70 (HSP70) level were measured from the blood of the umbilical cord after the delivery. Apgar scores of the newborns were also recorded. Results There was a significant difference in the temperature between EA and control group one hour after the treatment of painless labor [ (36.9±0.7) and (36.4±0.5)℃]. The level of serum IL-1β and HSP70 were significantly higher in EA group [IL-1β: (0.308±0.036) ng/mL; HSP70: 1.175±0.196] than those in the control group [IL-1β: (0.244±0.031) ng/mL; HSP70: 0.935±0.308] (P<0.05). However, no significant difference was found in the neonatal Apgar score (P>0.05). Conclusions The increase of maternal temperature is greater in the EA labor puerperants compared with that in the controls, which may be related to the increase of IL-1β and HSP70. No adverse effect of labor analgesia on new borns is found

Citation： LIN Yuangui, LUO Linli. The effect of epidural analgesia for labor on maternal temperature. West China Medical Journal, 2017, 32(7): 1011-1014. doi: 10.7507/1002-0179.201701100 Copy

1.	劉芝建, 都君君. 硬膜外分娩鎮痛對新生兒 Apgar 評分的影響. 實用兒科臨床雜志, 2009, 24(22): 1732-1736.
2.	Tian FB, Wang K, Hu JY, et al. Continuous spinal anesthesia with sufentanil in labor analgesia can induce maternal febrile responses in puerperas. Int J Clin Exp Med, 2013, 6(5): 334-341.
3.	Van De Velde M, Dreelinck R, Dubios J, et al. Determination of the full dose-response relation of intrathecal bupivacaine, levobupivacaine, and ropivacaine combined with sufentanil, for labor analgesia . Anesthesiology, 2007, 106(3): 149-156.
4.	Wong CA, Ratliff JT, Sullivan J, et al. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg, 2006, 102(1): 904-909.
5.	周朝明, 黎君君, 龔祖康, 等. 開展分娩鎮痛的宣教與管理體會. 中國醫藥導報, 2011, 29(8): 715-719.
6.	馮善武, 徐世琴, 王嫻, 等. 規律間斷給藥用于硬膜外分娩鎮痛對產婦產間發熱的影響. 臨床麻醉學雜志, 2015, 31(9): 858-861.
7.	Arendt KW, Segal BS. The association between epidural labor analgesia and maternal fever. Clin Perinatol, 2013, 40(3): 385-398.
8.	Goetzl L, Evans T, Rivers J, et al. Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever. P Am J Obstet Gynecol, 2002, 187(4): 834-838.
9.	Goetzl L, Zighelboim I, Badell M, et al. Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial. P Am J Obstet Gynecol, 2006, 195(4): 1031-1037.
10.	姜愛芬, 徐旭仲, 黃志蓮, 等. 老年人胃癌術后硬膜外鎮痛對 IL-1、IL-6、TNF-α 及皮質醇水平的影響. 溫州醫科大學學報, 2003, 33(3): 184-185.
11.	Sarikus Z, Bedirli N, Yilmaz G, et al. The effects of epidural bupivacaine on ischemia/reperfusion-induced liver injury. Bratisl Lek Listy, 2016, 117(1): 41-46.
12.	李真, 王慶, 王志鵬, 等. 全麻復合硬膜外阻滯對高血壓大鼠心肌 c-fos 和 HSP70 基因表達的影響. 南方醫科大學學報, 2010, 30(11): 2492-2494.
13.	Segal S. Labor epidural analgesia and maternal fever. Anesth Analg, 2010, 111(6): 1467-1475.
14.	Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. P Am J Obstet Gynecol, 2002, 186(5): 69-77.
15.	Greenwell EA, Wyshak G, Ringer SA, et al. Intrapartum temperature elevation, epiduraluse, and adverse outcome in term infants. Pediatrics, 2012, 129(2): 447-454.

1. 劉芝建, 都君君. 硬膜外分娩鎮痛對新生兒 Apgar 評分的影響. 實用兒科臨床雜志, 2009, 24(22): 1732-1736.
2. Tian FB, Wang K, Hu JY, et al. Continuous spinal anesthesia with sufentanil in labor analgesia can induce maternal febrile responses in puerperas. Int J Clin Exp Med, 2013, 6(5): 334-341.
3. Van De Velde M, Dreelinck R, Dubios J, et al. Determination of the full dose-response relation of intrathecal bupivacaine, levobupivacaine, and ropivacaine combined with sufentanil, for labor analgesia . Anesthesiology, 2007, 106(3): 149-156.
4. Wong CA, Ratliff JT, Sullivan J, et al. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg, 2006, 102(1): 904-909.
5. 周朝明, 黎君君, 龔祖康, 等. 開展分娩鎮痛的宣教與管理體會. 中國醫藥導報, 2011, 29(8): 715-719.
6. 馮善武, 徐世琴, 王嫻, 等. 規律間斷給藥用于硬膜外分娩鎮痛對產婦產間發熱的影響. 臨床麻醉學雜志, 2015, 31(9): 858-861.
7. Arendt KW, Segal BS. The association between epidural labor analgesia and maternal fever. Clin Perinatol, 2013, 40(3): 385-398.
8. Goetzl L, Evans T, Rivers J, et al. Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever. P Am J Obstet Gynecol, 2002, 187(4): 834-838.
9. Goetzl L, Zighelboim I, Badell M, et al. Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial. P Am J Obstet Gynecol, 2006, 195(4): 1031-1037.
10. 姜愛芬, 徐旭仲, 黃志蓮, 等. 老年人胃癌術后硬膜外鎮痛對 IL-1、IL-6、TNF-α 及皮質醇水平的影響. 溫州醫科大學學報, 2003, 33(3): 184-185.
11. Sarikus Z, Bedirli N, Yilmaz G, et al. The effects of epidural bupivacaine on ischemia/reperfusion-induced liver injury. Bratisl Lek Listy, 2016, 117(1): 41-46.
12. 李真, 王慶, 王志鵬, 等. 全麻復合硬膜外阻滯對高血壓大鼠心肌 c-fos 和 HSP70 基因表達的影響. 南方醫科大學學報, 2010, 30(11): 2492-2494.
13. Segal S. Labor epidural analgesia and maternal fever. Anesth Analg, 2010, 111(6): 1467-1475.
14. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. P Am J Obstet Gynecol, 2002, 186(5): 69-77.
15. Greenwell EA, Wyshak G, Ringer SA, et al. Intrapartum temperature elevation, epiduraluse, and adverse outcome in term infants. Pediatrics, 2012, 129(2): 447-454.

West China Medical Journal

The effect of epidural analgesia for labor on maternal temperature

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