The impact of opioid-free labor epidural analgesia maternal and infant outcomes: a retrospective cohort study

Background: Opioid Epidural Labor Analgesia (OLEA) is commonly used during labor. However, opioid use has been associated with adverse effects on maternal and fetal outcomes. Medications administered during epidural analgesia are systemically absorbed; therefore, we performed a retrospective cohort study to investigate whether Opioid-Free Labor Epidural Analgesia (OFLEA) is comparable to OLEA regarding maternal and infant outcomes at delivery. Methods: Of 1,423 patients initially identified, we excluded those with twin deliveries, duplicate records, or incomplete data. We then matched 1:1 on the mother's age, including 618 patients for final data analysis. Our OLFEA group included an epidural solution of 0.2% ropivacaine, while our OLEA group included an epidural solution of 0.1% ropivacaine + 250 mcg fentanyl. Wilcoxon rank-sum tests were performed to assess our primary outcome of time-weighted pain scores before and after epidural placement. Secondary outcomes included duration (minutes) of maternal hypotension, tachycardia, and bradycardia episodes during labor, and incidence of neonatal fever, C-section, and Apgar scores (1 and 5 mins after delivery). Results: There was no significant difference between the OLEA and OFLEA groups in the time-weighted pain scores during labor before epidural placement. However, the time-weighted pain score was significantly lower in the OFLEA group (1.05 ± 1.52) compared to OLEA (1.43 ± 1.77, p = 0.006). Similarly, maximum pain scores after epidural were lower in OFLEA (3.32 ± 3.23) vs. OLEA (3.87 ± 3.33, p = 0.03). There were no significant differences in maternal hemodynamic events, Apgar scores, neonatal fever, or cesarean delivery rates. Conclusions: OFLEA is a safe and feasible alternative to OLEA. Avoidance of opioids may support safer maternal and neonatal care in obstetric anesthesia.