• M J A Wilson, C Macarthur, A Shennan, and COMET Study Group (UK).
• Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. matthew.wilson@sth.nhs.uk
• Br J Anaesth. 2009 Jan 1;102(1):97-103.

BackgroundDense perineal block from epidural analgesia increases the risk of urinary catheterization in labour. Mobile epidurals using low-dose local anaesthetic in combination with opioid preserve maternal mobility and may reduce the risk of bladder dysfunction. We conducted a three-arm randomized controlled trial to compare high-dose epidural pain relief with two mobile epidural techniques.MethodsA total of 1054 primparous women were randomized to receive high-dose bupivacaine, epidural analgesia (Control), combined spinal epidural (CSE), or low-dose infusion (LDI). The requirement for urinary catheterization during labour and postpartum was recorded. Both end points were pre-specified secondary trial outcomes. Women were evaluated by postnatal interview, when their bladder function had returned to normal.ResultsRelative to Control, more women who received mobile epidural techniques maintained the ability to void urine spontaneously at any time (Control 11%, CSE 31% and LDI 32%) and throughout labour (Control 3.7%, CSE 13% and LDI 14%), for both mobile techniques P<0.01. There was no difference in the requirement for catheterization after delivery. Women in the CSE group reported a more rapid return of normal voiding sensation, relative to high-dose Control (P=0.02).ConclusionsRelative to conventional high-dose block, mobile epidural techniques encourage the retention of normal bladder function and reduce the risk of urinary catheterization in labour.

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