Antibiotic prophylaxis is commonly used for many types of procedures. Patients who receive epidural analgesia for pain relief during labor may become febrile and this may be due to infection of the amniotic cavity or even an infected fetus. Is it appropriate to use antibiotic prophylaxis for patients who receive epidural analgesia during labor?
Dr. Shiv K. Sharma, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX and colleagues randomized healthy nulliparous patients to receive either cefoxitin 2 g or placebo before placement of an epidural catheter. Their results are described in the article titled “A Randomized Trial of the Effects of Antibiotic Prophylaxis on Epidural-Related Fever in Labor,” which will soon be published in Anesthesia & Analgesia.
Four hundred patients were included in the study. Fever incidence was about 40% and did not differ between groups. Of the 302 placentas available for study (slightly less than 75%), neutrophilic inflammation was no different between the groups. Infant outcomes, such as fever, or Apgar score at 1 and 5 minutes, were also no different between groups.
Are these results surprising? Given the uncertainty surrounding why parturients get febrile with epidural analgesia, probably not. The relationship between labor epidural analgesia and fever was recently described in this journal in the article “Labor epidural analgesia and maternal fever” published in 2010.