Effect of labor analgesia using programmed intermittent epidural boluses on postpartum depression symptoms: A randomized controlled trial.

Background: Postpartum depression (PPD) is a serious concern with multifactorial etiology. Association between prenatal anxiety, pain, and depression has been theorized.

Aim: In this randomized controlled trial, we studied the effect of pain relief by combined spinal epidural (CSE) and other factors influencing PPD.

Methods: After thorough assessment and obtaining prenatal baseline parameters, parturients were randomly assigned to group 1 (CSE) and group 2 (control) (n = 31 each). Group 1 received 0.5 ml of 0.5% hyperbaric bupivacaine with 12.5 mcg of fentanyl intrathecally and 6 ml of 0.1% levobupivacaine with 2 mcg/ml fentanyl programmed intermittent epidural bolus every 60 min and patient-controlled epidural analgesia (PCEA) bolus of the same drug with a lockout interval of 15 min. Group 2 underwent normal vaginal delivery without neuraxial analgesia. Patients in both the groups were assessed for PPD using Edinburgh Postnatal Depression Scale (EPDS) at day 3 and 6 weeks postpartum.

Results: The EPDS score at 6 weeks postpartum was significantly lower in group 1 than in group 2 (P < 0.05). The pain score assessed using visual analog scale was significantly lesser in group 1 than in group 2 (P < 0.001). Multivariate linear regression analysis showed that prenatal anxiety, greater pain interference scores, and perceived stress were major determinants of PPD.

Conclusion: CSE analgesia using PCEA pump with PIEB facility in laboring parturients resulted in lesser EPDS scores and hence lesser postpartum depression. Effective pain control may be an important component to prevent PPD.