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BJA Advance Access originally published online on November 5, 2008
British Journal of Anaesthesia 2009 102(1):97-103; doi:10.1093/bja/aen313
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Urinary catheterization in labour with high-dose vs mobile epidural analgesia: a randomized controlled trial

M. J. A. Wilson1,*, C. MacArthur2, A. Shennan3 On behalf of the COMET Study Group (UK)

1 Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
2 Maternal and Child Epidemiology, Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT, UK
3 Obstetrics, Maternal and Fetal Research, Unit King's and St Thomas' School of Medicine, London SE1 7EH, UK

* Corresponding author. E-mail: matthew.wilson{at}sth.nhs.uk

Background: Dense perineal block from epidural analgesia increases the risk of urinary catheterization in labour. Mobile epidurals using low-dose local anaesthetic in combination with opioid preserve maternal mobility and may reduce the risk of bladder dysfunction. We conducted a three-arm randomized controlled trial to compare high-dose epidural pain relief with two mobile epidural techniques.

Methods: A total of 1054 primparous women were randomized to receive high-dose bupivacaine, epidural analgesia (Control), combined spinal epidural (CSE), or low-dose infusion (LDI). The requirement for urinary catheterization during labour and postpartum was recorded. Both end points were pre-specified secondary trial outcomes. Women were evaluated by postnatal interview, when their bladder function had returned to normal.

Results: Relative to Control, more women who received mobile epidural techniques maintained the ability to void urine spontaneously at any time (Control 11%, CSE 31% and LDI 32%) and throughout labour (Control 3.7%, CSE 13% and LDI 14%), for both mobile techniques P<0.01. There was no difference in the requirement for catheterization after delivery. Women in the CSE group reported a more rapid return of normal voiding sensation, relative to high-dose Control (P=0.02).

Conclusions: Relative to conventional high-dose block, mobile epidural techniques encourage the retention of normal bladder function and reduce the risk of urinary catheterization in labour.

Keywords: anaesthetic techniques, epidural; labour


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Home page
 Br J AnaesthHome page
C. F. Weiniger, M. J. A. Wilson, and (on behalf of the COMET Study Group)
Urinary catheterization in labour
Br. J. Anaesth., April 1, 2009; 102(4): 563 - 564.
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Urinary catheterization in labour
Carolyn F Weiniger
British Journal of Anaesthesia, 22 Dec 2008 [Full text]
Re: Urinary catheterization in labour
Matthew J Wilson
British Journal of Anaesthesia, 29 Dec 2008 [Full text]

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