ORIGINAL ARTICLE| Volume 20, ISSUE 4, P312-317, October 2011

Download started.


The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study

Published:August 16, 2011DOI:



      Labor epidural analgesia is associated with maternal hyperthermia. This pilot study compared the effects on maternal temperature during labor of different timing of initiation of the epidural component of combined spinal–epidural analgesia.


      After induction of analgesia with intrathecal bupivacaine 2 mg and fentanyl 20 μg, healthy term nulliparas in spontaneous labor were randomized to receive immediate epidural analgesia (n = 26) or delayed epidural analgesia after the return of pain (n = 28), by patient-controlled epidural analgesia with 0.125% bupivacaine and fentanyl 1 μg/mL. Maternal tympanic temperature, visual analog scale pain score and dermatome block level were measured hourly during labor.


      The duration of labor for most parturients (83.3%) was <5 h. Mean maternal temperature gradually increased over time but did not significantly differ from either from baseline or between the two groups. There was no significant difference in the incidence of maternal fever (⩾38°C) between the two groups. At 2 h post spinal analgesia the visual analog scale score was higher (P = 0.03) and the dermatome block level was lower (P = 0.005) in the delayed epidural analgesia group compared to the immediate epidural analgesia group.


      Delaying the epidural component of combined spinal–epidural analgesia did not significantly affect maternal temperature in the study population of whom 83.3% had a labor of <5 h. However, this study was underpowered to detect a difference in the incidence of fever and a larger prospective study is required.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fusi L.
        • Steer P.J.
        • Maresh M.J.
        • Beard R.W.
        Maternal pyrexia associated with the use of epidural analgesia in labour.
        Lancet. 1989; 1: 1250-1252
        • Camann W.R.
        • Hortvet L.A.
        • Hughes N.
        • Bader A.M.
        • Datta S.
        Maternal temperature regulation during extradural analgesia for labour.
        Br J Anaesth. 1991; 67: 565-568
        • Goetzl L.
        • Rivers J.
        • Zighelboim I.
        • Wali A.
        • Badell M.
        • Suresh M.S.
        Intrapartum epidural analgesia and maternal temperature regulation.
        Obstet Gynecol. 2007; 109: 687-690
        • Sharma S.K.
        • Alexander J.M.
        • Messick G.
        • et al.
        Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women.
        Anesthesiology. 2002; 96: 546-551
        • Dashe J.S.
        • Rogers B.B.
        • McIntire D.D.
        • Leveno K.J.
        Epidural analgesia and intrapartum fever: placental findings.
        Obstet Gynecol. 1999; 93: 341-344
        • Smulian J.C.
        • Bhandari V.
        • Vintzileos A.M.
        • et al.
        Intrapartum fever at term: serum and histologic markers of inflammation.
        Am J Obstet Gynecol. 2003; 188: 269-274
        • Goetzl L.
        • Evans T.
        • Rivers J.
        • Suresh M.S.
        • Lieberman E.
        Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever.
        Am J Obstet Gynecol. 2002; 187: 834-838
        • Mantha V.R.
        • Vallejo M.C.
        • Ramesh V.
        • Phelps A.L.
        • Ramanathan S.
        The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial.
        Int J Obstet Anesth. 2008; 17: 123-129
        • Miro M.
        • Guasch E.
        • Gilsanz F.
        Comparison of epidural analgesia with combined spinal–epidural analgesia for labor: a retrospective study of 6497 cases.
        Int J Obstet Anesth. 2008; 17: 15-19
        • Goodman S.R.
        • Smiley R.M.
        • Negron M.A.
        • Freedman P.A.
        • Landau R.
        A randomized trial of breakthrough pain during combined spinal–epidural versus epidural labor analgesia in parous women.
        Anesth Analg. 2009; 108: 246-251
        • Vallejo M.C.
        • Kaul B.
        • Adler L.J.
        • et al.
        Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour.
        Can J Anesth. 2001; 48: 1122-1126
        • Segal S.
        Labor epidural analgesia and maternal fever.
        Anesth Analg. 2010; 111: 1467-1475