• D Luxman, I Wolman, A Groutz, J R Cohen, M Lottan, D Pauzner, and M P David.
• Department of Obstetrics and Gynecology B, Lis Maternity Hospital, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
• Int J Obstet Anesth. 1998 Jul 1; 7 (3): 161-4.

AbstractThis study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. In group 1 (30 patients, early administration), the epidural catheter was sited and the first epidural injection of 0.25% bupivacaine administered at a cervical dilatation of <4 cm; group 2 (30 patients, late administration) received the epidural catheter and first epidural injection of 0.25% bupivacaine at a cervical dilatation of >or=4 cm. The progression and outcome of labor were compared between the two groups. There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.

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