Article Data

  • Views 2478
  • Dowloads 184

Original Research

Open Access

Mapping theme trends and knowledge structure of labor analgesia: a quantitative, co-word biclustering analysis of data in 2000-2020

  • Xue Bai1
  • Zi-Xuan Song2
  • Yu-Xiao Wan3
  • Zhi-Qiang Feng4
  • Dong-Hai Yu5
  • Dan-Dan Zhang2

1Shengjing Hospital of China Medical University, Department of Health Management, Shenyang, P. R. China

2Shengjing Hospital of China Medical University, Department of Obstetrics and Gynecology, Shenyang, P. R. China

3Shengjing Hospital of China Medical University, Department of Anesthesiology, Shenyang, P. R. China

4Affiliated Zhongshan Hospital of Dalian University, Department of Anesthesiology, Dalian, P. R. China

5Dalian Central Hospital, Department of Anesthesiology, Dalian, P. R. China

DOI: 10.22514/sv.2021.012 Vol.17,Issue 4,July 2021 pp.98-107

Submitted: 22 November 2020 Accepted: 30 December 2020

Published: 08 July 2021

*Corresponding Author(s): Dan-Dan Zhang E-mail:


Background: The distribution knowledge structure and pattern of the literature on labor analgesia in PubMed were examined.

Methods: Scientific papers on labor analgesia published from 1 January, 2000 to 31 June, 2020 were retrieved. The extracted MeSH items were quantitatively analyzed by the Bibliographic Item Co-Occurrence Matrix Builder (BICOMB), and the high frequency MeSH items were identified. In gCLUTO software, repeated bisection method was used to Mountain visualisation, and the visual matrix was established. By constructing high-frequency MeSH terms co-occurrence matrix, strategic diagram and social network are further completed.

Results: The search strategy yielded 2870 papers, and the number of papers published annually had changed slightly during the study period. Among all extracted MeSH terms, 42 high-frequency MeSH terms were identified by consensus, and were divided into six categories by diclustering analysis. In the strategic diagram, the methods of labor analgesia, drug doses, and routes of administration were properly presented. In contrast, statistical and numerical data on obstetric analgesia were relatively underdeveloped, and management of pain during labor was undeveloped. In the social network analysis, the position status of each component was determined by the centrality values.

Conclusions: The findings on labor analgesia are relatively divergent, and the six research categories outlined in this study reflect the publication trends in the field of labor analgesia to some extent. Our quantitative bibliometric research across a 20-year span depicts the overall direction of the latest topics and provides some hints for researchers when launching new projects.


Labor analgesia; Bibliometric analysis; Co-word analysis; Social network analysis

Cite and Share

Xue Bai,Zi-Xuan Song,Yu-Xiao Wan,Zhi-Qiang Feng,Dong-Hai Yu,Dan-Dan Zhang. Mapping theme trends and knowledge structure of labor analgesia: a quantitative, co-word biclustering analysis of data in 2000-2020. Signa Vitae. 2021. 17(4);98-107.


[1] American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. American Academy of Pediatrics. 2002.

[2] Obstetric care consensus No. 2: levels of maternal care. Obstetrics & Gynecology. 2015; 125: 502-515.

[3] Dexter F. Visual analog scale scores for labor pain. Anesthesia and Analgesia. 1999; 88: 1421.

[4] Ogboli-Nwasor E, Adaji S, Bature S, Shittu O. Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria. Journal of Pain Research. 2011; 4: 227-232.

[5] El-Wahab N, Robinson N. Analgesia and anaesthesia in labour. Obstet-rics, Gynaecology & Reproductive Medicine. 2011; 21: 137-141.

[6] Gu D, Yang X, Deng S, Liang C, Wang X, Wu J, et al. Tracking knowledge evolution in cloud health care research: knowledge map and common word analysis. Journal of Medical Internet Research. 2020; 22: e15142.

[7] Landis JR, Koch GG. A one-way components of variance model for categorical data. Biometrics. 1977; 33: 671-679.

[8] Li F, Li M, Guan P, Ma S, Cui L. Mapping publication trends and identifying hot spots of research on Internet health information seeking behavior: a quantitative and co-word biclustering analysis. Journal of Medical Internet Research. 2015; 17: e81.

[9] Ling WX. Clinical observation on nitrogen monoxide for delivery analgesia. Chinese Medicine Modern Distance Education of China. 2013.

[10] Ismail MT, Hassanin MZ. Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women. Archives of Gynecology and Obstetrics. 2013; 286: 1375-1381.

[11] Tveit TO, Seiler S, Halvorsen A, Rosland JH. Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl. European Journal of Anaesthesiology. 2012; 29: 129-136.

[12] Hill JB, Alexander JM, Sharma SK, McIntire DD, Leveno KJ. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstetrics and Gynecology. 2003; 102: 333-337.

[13] Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005; 103: 645-653.

[14] Shen X, Li Y, Xu S, Wang N, Fan S, Qin X, et al. Epidural analgesia during the second stage of labor: a randomized controlled trial. Obstetrics and Gynecology. 2017; 130: 1097-1103.

[15] Lv B, Wang W, Wang Z, Wang X, Wang J, Fang F, et al. Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis. Current Medical Research and Opinion. 2014; 30: 2279-2289.

[16] Li Y, Hu C, Fan Y, Wang H, Xu H. Epidural analgesia with amide local anesthetics, bupivacaine, and ropivacaine in combination with fentanyl for labor pain relief: a meta-analysis. Medical Science Monitor. 2015; 21: 921-928.

[17] Guo S, Li B, Gao C, Tian Y. Epidural analgesia with bupivacaine and fentanyl versus ropivacaine and fentanyl for pain relief in labor: a meta-analysis. Medicine. 2015; 94: e880.

[18] Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Canadian Journal of Anesthesia. 2013; 60: 840-854.

[19] Craig MG, Grant EN, Tao W, McIntire DD, Leveno KJ. A randomized control trial of bupivacaine and fentanyl versus fentanyl-only for epidural analgesia during the second stage of labor. Anesthesiology. 2015; 122: 172- 177.

[20] Heesen M, Böhmer J, Klöhr S, Hofmann T, Rossaint R, Straube S. The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor, maternal, and neonatal outcomes. Anesthesia & Analgesia. 2015; 121: 149-158.

[21] Capogna G, Camorcia M, Stirparo S, Farcomeni A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesthesia & Analgesia. 2011; 113: 826-831.

[22] Feng S, Xu S, Ma L, Li C, Wang X, Yuan H, et al. Regular intermittent bolus provides similar incidence of maternal fever compared with continuous infusion during epidural labor analgesia. Saudi Medical Journal. 2015; 35: 1237-1242.

[23] Leo S, Ocampo CE, Lim Y, Sia AT. A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. International Journal of Obstetric Anesthesia. 2010; 19: 357-364.

[24] Patkar C, Vora K, Patel H, Shah V, Modi M, Parikh G. A comparison of continuous infusion and intermittent bolus administration of 0.1 ropivacaine with 0.0002 fentanyl for epidural labor analgesia. Journal of Anaesthesiology Clinical Pharmacology. 2015; 31: 234-238.

[25] Sng BL, Zhang Q, Leong WL, Ocampo C, Assam PN, Sia ATH. Incidence and characteristics of breakthrough pain in parturients using computer-integrated patient-controlled epidural analgesia. Journal of Clinical Anesthesia. 2015; 27: 277-284.

[26] Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. The Cochrane Database of Systematic Reviews. 2011; 4: CD000331.

[27] Cossu AP, De Giudici LM, Piras D, Mura P, Scanu M, Cossu M, et al. A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. International Journal of Obstetric Anesthesia. 2015; 24: 237-246.

[28] Hung TH, Hsieh TT, Liu HP. Differential effects of epidural analgesia on modes of delivery and perinatal outcomes between nulliparous and multiparous women: a retrospective cohort study. PLoS ONE. 2015; 10: e0120907.

[29] El-Kerdawy H, Farouk A. Labor analgesia in preeclampsia: remifentanil patient controlled intravenous analgesia versus epidural analgesia. Middle East Journal of Anaesthesiology. 2010; 20: 539-545.

[30] Ranganathan P, Golfeiz C, Phelps AL, Singh S, Shnol H, Paul N, et al. Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population. Journal of Clinical Anesthesia. 2016; 27: 201-206.

[31] Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. The New England Journal of Medicine. 2005; 352: 655-665.

[32] Wang F, Shen X, Guo X, Peng Y, Gu X. Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a 5-year randomized controlled trial. Obstetric Anesthesia Digest. 2010; 30: 185-187.

[33] Torvaldsen S, Roberts CL, Bell JC, Raynes-Greenow CH. Discontinua-tion of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. The Cochrane Database of Systematic Reviews. 2004; 4: CD004457.

[34] George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesthesia and Analgesia. 2013; 116: 133-144.

[35] Butwick AJ. 2012 Gerard W. Ostheimer lecture-what’s new in obstetric anesthesia? International Journal of Obstetric Anesthesia. 2012; 21: 348-356.

[36] Camorcia M, Capogna G, Stirparo S, Berritta C, Blouin JL, Landau R. Effect of µ-opioid receptor A118G polymorphism on the ED50 of epidural sufentanil for labor analgesia. International Journal of Obstetric Anesthesia. 2012; 21: 40-44.

[37] Pettersson FD, Grönbladh A, Nyberg F, Sundström-Poromaa I, Åkerud H. The A118G single-nucleotide polymorphism of human µ-opioid receptor gene and use of labor analgesia. Reproductive Sciences. 2012; 19: 962-967.

[38] Zhang N, Xu M. Effects of epidural neostigmine and clonidine in labor analgesia: a systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Research. 2015; 41: 214-221.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time