EXPERIENCES WITH LUMBAR EXTRADURAL ANALGESIA FOR CAESAREAN SECTION

The results of 324 Caesarean sections conducted under lumbarextradural block are discussed. In addition to pre-loading withfluid i.v. and the avoidance of aorto-caval compression, morerecent modifications have been to administer bupivacaine inincremental doses, to be less concerned with the size of thetotal dose, and to provide the mother with supplementary oxygenuntil delivery. As a result of these modifications, the frequencyof maternal discomfort and hypotension has been reduced, andthe need for supplementary analgesia or a vasopressor has becomea rarity. Administration of diazepam after delivery is stilloccasionally advisable. The technique has many advantages forboth mother and infant and with a good obstetric service, fewdisadvantages. Prolongation of the interval between incisionof the myometrium and delivery appears to be less detrimentalto the infant than is the case when general anaesthesia is used.