Forceps delivery and the use of synthetic opioid analgesia during epidural anaesthesia

Objective: To verify whether the use of sufentanil during obstetric epidural anaesthesia (EA) was accompanied by an increase in the rate of instrumental extraction. Study design: We made a retrospective comparison of deliveries that occurred during two 3-year periods (1993-1995, and 1997-1999), before and after the introduction of sufentanil into our protocol for epidural anaesthesia. Results: The first period covered 4694 deliveries compared with 5310 in the second; for these periods, the EA rate rose from 48.55 to 63.36% (P = 0.0001). The rates of uncomplicated vaginal delivery, forceps delivery and caesarian section over the two periods were 70.24, 12.76 and 17% versus 67.08, 14.41 and 18.51%, respectively: the differences were statistically significant. The indications for the use of forceps did not differ during the two periods. During vaginal delivery, the rate of forceps use as a function of EA administration/non-administration was remarkably constant over the two periods: 25.8% with EA versus 6.2% without EA in the first period compared with 24.9 and 6.2% in the second period. The forceps delivery rate was unaffected by the fact that EA was carried out by an anaesthetist specialised in obstetrics. Conclusion: The addition of sufentanil to our protocol for EA has not altered the practice of instrumental extraction in our department. With EA, the rate of forceps delivery is multiplied by 4, irrespective of the protocol used. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.