Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. However, there have recently been a number of well-designed RCTs of epidural vs non-epidural analgesia that seem to have finally addressed some of the issues surrounding epidural analgesia in labour. Maternal satisfaction is an important measure but is influenced by many other factors, including outcome of labour, support and interaction obatetric staff, and control over pain rather than its amelioration.
There is a theoretical risk of damage to the neurological structures within the pelvis with longer labours, but this is difficult to quantify. Examples of typical epidural regimens are shown in Table 2.
Other drugs that have been investigated include epinephrine, ketamine, neostigmine, remifentanil and midazolam. Various explanations have been proposed, including opioid-induced uterine hyperstimulation and placental hypoperfusion secondary to a fall in maternal blood pressure and 0.
No consistent differences obstetdic been identified in neonatal arterial pH or APGAR scores in babies who are born to mothers with epidurals. The ideal local anaesthetic for labour analgesia would produce a reliable sensory block, no motor block and be safe in overdose or when inadvertently administered i.
Sign In or Create an Account. A double-blind comparison of 0. The effectiveness of analgesia was better. However, monitoring of the fetus remains important. The following statement from the American College of Obstetricians and Gynecologists summarizes the background to these figures: Once again, the clinical importance of these isolated reports is unclear. The low-dose regimen provides effective, rapid onset analgesia and high maternal satisfaction rates when compared with traditional top-ups.
This would suggest that ropivacaine does not have a superior sensory-motor split when compared with bupivacaine. It has been suggested that confining women to bed during labour may cause labour to be longer and more painful, and increase the incidence of malpresentations and therefore instrumental deliveries.
Good communication and a team effort are needed to reap the benefits of pain free labour, while minimizing the potential effect of epidural analgesia on labour outcome. Perioperative Management All Journals search input. Factors contributing to the outcome of labour are multiple and complex. Combined spinal epidural versus epidural analgesia in oobstetric. There is obstetic evidence that refutes some of these claims.
Several recent large RCTs comparing epidural with non-epidural analgesia during labour have shown that epidural analgesia does not increase the caesarean section rate, whether attributable to dystocia or fetal distress. Fentanyl is perhaps the most commonly used opioid in the UK. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome.
On the other hand, CSE may reduce accidental dural puncture rates. The effect of a rapid change in availability of epidural analgesia on the Cesarean delivery rate: It provides effective analgesia and high maternal satisfaction rates, as mothers feel they are in control of their analgesia.
The clinical relevance of this is unclear. Experience in three thousand cases. Maternal satisfaction may be increased by the fact that even if not ambulant, women are more mobile in bed.
If women do ambulate, obststric should be accompanied at all times, as minor degrees of motor block and impaired proprioception may increase the risk of falling. Factors contributing to the outcome of labour are multiple and complex. CJA ; 47 8: Presumably this is the result of the preservation of muscle tone and the bearing down reflex. It has been suggested that confining women to bed during labour may cause labour to be longer and more painful, and increase the incidence of malpresentations and therefore instrumental deliveries.
Chloroprocaine and lidocaine are also used in the obstetric setting; they are not suitable for analgesia. Epidural analgesia does not increase caesarean section rates. A greater proportion of parturient achieved a maximum level of analgesia unto T8. Email this article Login required. It provides effective analgesia and high maternal satisfaction rates, as mothers feel they are in control of their analgesia.
This is labour intensive for staff, provides intermittent analgesia and can cause haemodynamic instability with each bolus. Sufentanil obsteteic used extensively in the US. The following statement from the American College of Obstetricians and Gynecologists summarizes the background to these figures: With low dose top-ups, there is a reduction in total LA obstetfic when compared with Patient-controlled epidural analgesia PCEA has proved a safe and reliable technique.
However we must strive to reduce any effect on duration of labour and instrumental vaginal delivery rates by minimizing motor block through the use of low-dose LA and opioid combinations. Compared with other methods, epidural analgesia provides superior analgesia in labour. CJA ; 38 3: The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery 0.
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