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

Kush S. Brahmbhatt; Ankith P. Reddy; Hiram A. Acevedo Bonilla; Ibrahim Tahashilder; Mohamed Ibrahim; Michelle Simon; Rakesh B. Vadhera; Rovnat Babazade

doi:10.1016/j.bjane.2026.844750

Original Investigation

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

O impacto da analgesia epidural de parto livre de opioides nos desfechos maternos e infantis: estudo retrospectivo de coorte

Kush S. Brahmbhatt, Ankith P. Reddy, Hiram A. Acevedo Bonilla, Ibrahim Tahashilder, Mohamed Ibrahim, Michelle Simon, Rakesh B. Vadhera, Rovnat Babazade

http://dx.doi.org/10.1016/j.bjane.2026.844750 Braz J Anesthesiol, vol.76, n3, 844750, 2026

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Abstract

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.

Keywords

Analgesia; Epidural; Infant; Mothers; Opioid epidemic; Pregnancy outcome

Resumo

Introdução

A analgesia epidural de parto com opioides (Opioid Epidural Labor Analgesia — OLEA) é comumente utilizada durante o trabalho de parto. Entretanto, o uso de opioides tem sido associado a efeitos adversos nos desfechos maternos e fetais. Os medicamentos administrados durante a analgesia epidural são absorvidos sistemicamente; portanto, realizamos um estudo retrospectivo de coorte para investigar se a analgesia epidural de parto livre de opioides (Opioid-Free Labor Epidural Analgesia — OFLEA) é comparável à OLEA em relação aos desfechos maternos e infantis no parto.

Métodos

Das 1.423 pacientes inicialmente identificadas, excluímos aquelas com gestação gemelar, registros duplicados ou dados incompletos. Em seguida, realizamos pareamento 1:1 pela idade materna, incluindo 618 pacientes para a análise final dos dados. O grupo OFLEA recebeu solução epidural de ropivacaína a 0,2%, enquanto o grupo OLEA recebeu solução epidural de ropivacaína a 0,1% + 250 mcg de fentanil. Foram realizados testes de soma de postos de Wilcoxon para avaliar o desfecho primário de escores de dor ponderados pelo tempo antes e após a colocação do cateter epidural. Os desfechos secundários incluíram duração (minutos) dos episódios de hipotensão, taquicardia e bradicardia maternas durante o trabalho de parto, além da incidência de febre neonatal, cesariana e escores de Apgar (1 e 5 minutos após o parto).

Resultados

Não houve diferença significativa entre os grupos OLEA e OFLEA nos escores de dor ponderados pelo tempo durante o trabalho de parto antes da colocação da epidural. Entretanto, o escore de dor ponderado pelo tempo foi significativamente menor no grupo OFLEA (1,05 ± 1,52) em comparação ao grupo OLEA (1,43 ± 1,77; p = 0,006). Da mesma forma, os escores máximos de dor após a epidural foram menores no grupo OFLEA (3,32 ± 3,23) em comparação ao grupo OLEA (3,87 ± 3,33; p = 0,03). Não houve diferenças significativas em eventos hemodinâmicos maternos, escores de Apgar, febre neonatal ou taxas de cesariana.

Conclusão

A OFLEA é uma alternativa segura e viável à OLEA. A evitação de opioides pode contribuir para cuidados maternos e neonatais mais seguros na anestesia obstétrica.

Palavras-chave

Analgesia; Epidural; Lactentes; Mães; Epidemia de opioides; Desfecho gestacional

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Submitted date:
06/11/2025

Accepted date:
12/22/2025