Effects of Different Neuraxial Analgesia Modalities on the Need for Physician Interventions in Labour: A Network Meta-analysis

( Eur J Anaesthesiol . 2024;41(6):411–420. doi: 10.1097/EJA.0000000000001986 Methods for initiating labor analgesia include epidural (EPI), combined spinal epidural (CSE), and dural puncture epidural (DPE). Methods for maintaining labor analgesia include patient-controlled epidural analgesia (PCEA), continuous epidural infusion (CLE), and programmed intermittent epidural bolus (PIEB). The best combination of labor analgesia initiation and maintenance is not agreed upon and inadequate labor analgesia increases the need for physician interventions, increases clinician workload, and decreases maternal satisfaction. Previous studies have focused on comparing different types of either labor analgesia initiation or maintenance techniques but this study investigated the impact of six commonly used combinations of initiation and maintenance techniques – EPI + CLE + PCEA; EPI + PIEB + PCEA; CSE + CLE + PCEA; CSE + PIEB + PCEA; DPE + CLE + PCEA; and DPE + PIEB + PCEA – on the need for primary physician interventions using network meta-analysis (NMA).