Friday, September 14, 2007

Epidurals vs Narcotics. Klein on the Meta-Analysis.

Dr. Klein speaking on the Cochrane meta-analysis of the Epidural vs Narcotics issue.

*in the past, these meta analyses showed a 10% increase in Cxion (his word again..sigh) with epidurals. This one doesn't..hmm.

*Quoting him "It is not the fault of the RCT as a methodology!!! It is the fault of the inclusion in the meta-analysis of studies that ought not to be there - or the studies need to be grouped or stratified according to their settings or approaches so one can know if the results apply to one's own setting."

THIS IS IMPORTANT. Cochrane is trusted, so we don't realize that the data is being SPUN!

*There was an inclusion of one study with a LARGE population that gave their epidurals late in labor, only in active labor. Without Sharma, there is a 4.3 hour increase with epidurals, with Sharma, it's only 1 hour increase (1st stage of labor); cesareans were higher, perineal trauma was higher, infant consequences higher. The book for this is very blurry, so I am hoping that Dr. Klein will forward me his slides so I can actually use this information with real stats.