Epidural catheter migration during labour

A study was undertaken to determine the incidence, magnitude and direction of catheter migration in 100 patients who had epidural analgesia for pain relief in labour. Over 50% of catheters migrated from the original position at siting. The relevance of this migration and the usefulness of its measurement are discussed.     

The effect of epidural analgesia in labour on maternal respiratory function

Lumbar epidural analgesia during labour has gained widespread acceptance. The impact of epidural analgesia based on mixtures of low-dose local anaesthetic solutions and lipophilic opioids on most clinically relevant obstetric outcomes is minimal. Since the pregnant state per se is associated with important alterations in respiration, we assessed whether a subtle degree of motor blockade brought about by epidural analgesia might compromise respiratory function as assessed by spirometry. Sixty consenting parturients receiving epidural analgesia were consecutively included in this prospective study. We performed spirometry during the antepartum visit and in labour after effective epidural analgesia was established; at both assessments the women were pain-free. Values were within normal ranges but increased significantly after effective epidural analgesia; median (IQR [range]) increase for vital capacity 7.4 (3.0-13 [-12-27])% (p < 0.001); forced vital capacity 4.4 (1.7-9.8 [-13-26])% (p < 0.001); forced expiratory volume in 1 s 5.5 (1.7-8.6 [-14-28])% (p < 0.001); and peak expiratory flow rate 2.3 (-1.6-5.8 [-18-16])% (p = 0.01)). We conclude that epidural analgesia for labour significantly improved respiratory function.     

Epidural bupivacaine dilution for labour

We have compared the effects of three epidural infusions in a randomised, double-blind study of 56 primigravid mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by infusion of either bupivacaine 0.125%, 0.062% or 0.031%. All solutions contained fentanyl 0.0002% and were run at 7.5 ml/hour. Women receiving the most dilute solution had significantly less analgesia (p less than 0.001) for the first 4 hours of the study, but pain scores were then similar for the three groups. No obvious benefit was gained by using very dilute bupivacaine.     

The extension of labour epidural analgesia for Caesarean section

Seven hundred and twenty-two patients who received epidural analgesia during labour were delivered by Caesarean section. The block was extended in 554 patients to provide analgesia for surgery. In twenty-one cases incomplete analgesia necessitated general anaesthesia. The main complications were maternal hypotension (15.9%) and vomiting (17.1%). Almost all patients expressed enthusiasm for the technique.     

硬膜外分娩镇痛对分娩方式的影响

目的 评价硬膜外分娩镇痛对分娩方式的影响.方法 初产妇400例,ASA Ⅰ或Ⅱ级,足月、单胎、头位,无妊娠并发症及硬膜外麻醉禁忌证.分为硬膜外镇痛组和非镇痛组(n=200).硬膜外镇痛组宫口开至3 cm时,采用0.1%罗哌卡因混合0.5 μg/ml舒芬太尼行硬膜外镇痛,宫口开全后停止镇痛.记录镇痛前和镇痛15 min时VAS评分;评价运动阻滞程度;记录分娩方式、第一产程、第二产程、新生儿出生后1、5 min时Apgar评分和新生儿体重;记录镇痛过程中不良反应的发生情况.结果 硬膜外镇痛组镇痛15 min时VAS评分由(8.3±0.8)分降至(1.6±1.1)分(P＜0.05).与非镇痛组比较,硬膜外镇痛组顺产率和阴道器械助产率升高,剖宫产率降低,第一产程和第二产程延长(P＜0.05).2组新生儿出生后1、5 min时Apgar评分和新生儿体重比较差异无统计学意义(P＜0.05).硬膜外镇痛组下肢运动阻滞发生率为0.5%,下肢麻木发生率为9.0%,恶心呕吐发生率为1.5%.结论 硬膜外分娩镇痛可降低剖宫产率,提高自然分娩率.     

The management of labour using continuous lumbar epidural analgesia in a patient with a malignant cerebral tumour

A mother presented at 28 weeks with epileptiform convulsions which were due to a malignant cerebral tumour. Labour and delivery at 34 weeks were managed under epidural analgesia. The infant was healthy, but the mother died several days later following cerebral decompression.     

An epidural infusion technique for labour

A regimen to facilitate control of epidural infusions in labour has been developed which allows midwives to alter infusion rates to maintain satisfactory analgesia. The technique was used successfully in 30 patients and, in a prospective study, was compared with women who received conventional top-up epidurals. It was found that infusions provided comparable analgesia and decreased midwife workload but resulted in a higher dosage of bupivacaine.     

硬膜外分娩镇痛对产妇子宫收缩的影响

目的 研究硬膜外分娩镇痛对产妇子宫收缩的影响。方法 随机选择20例有分娩镇痛要求且无产科并发症的单胎初产妇为试验组(E组)，另随机选取拒绝接受分娩镇痛的同类产妇20例为对照组(C组)。在 E 组产妇宫口开3.0cm 时行 L_(2～3)间隙硬膜外穿刺，接电脑镇痛泵行病人自控镇痛。分别测定产妇宫口开3cm(T_1)、宫口开3cm 后1h(T_2)和宫口开全时(T_3)血浆前列腺素 E_2(PGE_2)、催产素和皮质醇浓度，以及胎儿娩出时脐静脉血浆和羊水中皮质醇、催产素和 PGE_2浓度。同时记录产妇宫缩情况、产程经过、分娩方式及新生儿 Apgar 评分。结果 与 T_1时相比，两组 T_2、T_3时血浆 PGE_2升高(P<0.05或O.01)，T_3时 C 组皮质醇浓度升高(P<0.05)；与 C 组相比，E 组产妇 T_2、T_3时血浆皮质醇浓度降低(P<0.05或0.01)，T_2时宫腔压力和宫缩持续时间降低(P<0.05或0.01)，_2时宫缩间隔时间较 C 组延长(P<0.01)。脐血和羊水各指标及 VAS 评分组间比较差异无显著性(P>0.05)。结论 硬膜外分娩镇痛可引起子宫收缩力的—过性下降，但其与子宫收缩激素无关，对分娩过程也没有不良影响。     

间断硬膜外间隙给药在分娩镇痛中的应用

背景 近年来,间断硬膜外间隙给药(intermittent epidural bolus,IEB)作为分娩镇痛的一种新型给药方式逐渐受到临床的关注. 目的 阐述当前IEB进行分娩镇痛的进展. 内容 综述IEB的局部麻醉药消耗量、镇痛效果、运动阻滞发生情况和对分娩结局的影响. 趋向 随着认识的深入,IEB将在分娩镇痛中得到更广泛的应用.     

Maternal opinion about analgesia for labour. A controlled trial between epidural block and intramuscular pethidine combined with inhalation

In a randomised controlled trial epidural analgesia with bupivacaine 0.5% (mean dose 112.8 mg) was compared with pethidine (mean dose 200 mg) and inhalational analgesia in primipara (28 and 30 mothers) and multipara (17 and 18 mothers). Mothers who had an uneventful pregnancy and labour and agreed to have either treatment were studied during labour and followed-up at interviews for 5 months after delivery. Epidural block was rated significantly superior in respect of pain relief and comfort, there were no differences between the groups in reports of perineal discomfort. Twice as many primipara required forceps delivery after epidural block. Very few mothers, in each group, reported something missing in their experience of childbirth. Two thirds of each group would use the same method again. Epidural block can therefore be recommended to uncommitted mothers as a satisfying and effective method of pain relief for labour.     

Some maternal complications of epidural analgesia for labour

A review of the maternal complications encountered in a consecutive series of over 27 000 lumbar epidural blocks (exclusive of epidurals administered for elective Caesarean section and complications of a relatively minor or fleeting nature) in a single obstetric unit is presented. There were nine potentially life threatening complications, of which only three caused real concern for the mother's safety. Six of these occurred with the first top-up, as given by the anaesthetist. The others were the result of three out of the approximately 100 000 top-ups administered by midwives. There were two serious, but not life-threatening complications, each of which led to the requirement of a laminectomy. In addition, there were 13 moderately serious and 17 mildly disturbing complications. All the mothers concerned made a full recovery. There was a large number of inconsequential or pseudocomplications which, although initially blamed upon the epidural, were later demonstrated to have been of a different origin. Consideration of this experience leads to the conclusion that if the rules of management are rigorously followed, epidural analgesia for labour and delivery, including topping-up by well-informed midwives, is characterised by an extremely high level of safety for the mother.     

Epidural blockade in the treatment of preterm labour

A case of premature labour induced by necrosis in a fibromyoma followed by laparotomy is described. Unsuccessful treatment with ritodrine was followed by successful treatment with epidural analgesia. The possible role of a sympathetic blockade is discussed.     

Extradural analgesia in labour

Chloroprocaine hydrochloride 2% and bupivacaine hydrochloride 0.375% in 10-ml doses of plain solutions were studied in a randomised blind manner as the agents for continuous lumbar extradural analgesia in labour. Twenty-four patients were assessed for the speed of onset, duration of action, degree of motor blockade, dermatomal spread, arterial hypotension, and the incidence of unblocked segments. Chloroprocaine showed a quicker onset time and a shorter duration of action than bupivacaine. Chloroprocaine exhibited more marked motor blockade and a lower incidence of unblocked segments. The dermatomal spread and effect on arterial pressure were similar in both groups.     

Epidural pethidine and bupivacaine in labour

A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.