Regional anesthesia improves success of external cephalic version

January 01, 0001

Regional anesthesia improves success of external cephalic version

This meta-analysis was conducted to estimate whether the use of regional anesthesia is associated with increased success of external cephalic version. Electronic databases were searched from 1966 through April 2011 for published, randomized controlled trials in the English language comparing regional anesthesia with no regional anesthesia for external cephalic version. The primary outcome was external cephalic version success. Secondary outcomes included cesarean delivery, maternal discomfort, and adverse events.

They found: "Six randomized controlled trials met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared with intravenous or no analgesia (59.7% compared with 37.6%; pooled relative risk 1.58). This significant association persisted when the data were stratified by type of regional anesthesia (spinal compared with epidural). The number needed to treat with regional anesthesia to achieve one additional successful external cephalic version was five. There was no evidence of statistical heterogeneity or publication bias. There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia with intravenous or no analgesia (48.4% compared with 59.3%; pooled relative risk 0.80). Adverse events were rare and not significantly different between the two groups."

The authors concluded: "Regional anesthesia is associated with a higher success rate of external cephalic version."

The effect is rather modest and if resources are lacking it still makes sense to proceed without regional anesthesia.

For the full abstract, click here.

Obstet Gynecol 118(5):1137-1144, November 2011 © 2011 to the American College of Obstetricians and Gynecologists
Effect of Regional Anesthesia on the Success Rate of External Cephalic Version: A Systematic Review and Meta-Analysis. Katherine R. Goetzinger, Lorie M. Harper, Methodius G. Tuuli, George A. Macones, Graham A. Colditz.

Category: W. Pregnancy, Family Planning. Keywords: external cephalic version, breech, regional anesthesia, spinal, epidural, meta-analysis of randomized controlled trials, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 November 2009

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.