Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede the progress of labor or depress the newborn. The incidence of side effects is low. Maintenance of analgesia that allows patient control enhances patient satisfaction.

2. LABOUR PAIN...
• MOST SEVERE PAIN ENDURED BY A WOMAN
IN HER LIFETIME
• VISCERAL AND SOMATIC COMPONENTS
• T10-11 & S2-S4.
• CAUSES MARKED STIMULATION OF
RESPIRATION & CIRCULATION & ACTIVATION
OF SYMPATHETIC NERVOUS SYSTEM.

3. INDICATION?
MATERNAL REQUEST IS A
SUFFICIENT INDICATION
FOR PAIN RELIEF IN LABOUR
- ACOG & ASA
ACOG Committee Opinion No. 295. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;104:213.

4. REGIONAL ANALGESIA TECHNIQUES
• EPIDURAL ANALGESIA-PCEA
• SUBARACHNOID BLOCK
• COMBINED SPINAL EPIDURAL BLOCK
• LUMBAR SYMPATHETIC BLOCK
• PARACERVICAL BLOCK
• PUDENDAL BLOCK

5. CONTRAINDICATIONS
• PATIENT REFUSAL
• LOCAL INFECTION
• RAISED ICP
• COAGULOPATHY
• UNCORRECTED MATERNAL HYPOVOLEMIA

6. LUMBAR EPIDURAL ANALGESIA
• GOLD STANDARD TECHNIQUE FOR OBSTETRIC ANALGESIA
• LOW DOSES OF LA+OPIOID IN EPIDURAL SPACE GIVES
CONTINUOUS T10-L1 SENSORY BLOCK DURING 1ST STAGE
OF LABOUR
• SAFE AND EFFECTIVE
• NO APPRECIABLE MOTOR BLOCK
• EXTENDED TO PROVIDE SURGICAL ANAESTHESIA
• PCEA.

8. COMPLICATIONS
• TRANSIENT HAEMODYNAMIC INSTABILITY
• ACCIDENTAL DURAL PUNCTURE-PDPH
• SPINAL CORD TRAUMA
• TRANSIENT PARAESTHESIAS.

9. COMBINED SPINAL EPIDURAL ANALGESIA

10. MYTHS AND CONTROVERSIES
• Lin Y et al.Dispelling the myths of epidural pain relief in childbirth.Singapore
Med J2006;47:1096
• Loughnan BA et al .Epidural analgesia and back ache-a randomised control
trial.BJA 2002;88:466-72
• Charlotte J Howell et al.Randomised study of long term outcome after
epidural versus non-epidural analgesia during labour.BMJ2002;325-357.
BACKACHE AND EPIDURAL NO

11. EARLY EPIDURAL & PROLONGED
SECOND STAGE?
• Weiczorek,IJOA 201019:273-77
• Uppal, Anaesthesia 2010,65:652.
• Kajekar,IJOA 2010,19:S44.
• NO AFFECT ON LENGTH OF LABOUR OR CAESAREAN RATES
• SHORTER LABOUR COMPARED WITH LATER EPIDURAL
PLACEMENT.
NO

12. INCREASED RATES OF OPERATIVE &
INSTRUMENTAL DELIVERY?
• Eriksen LM et al.Mode of delivery after epidural analgesia in a
cohort of low-risk nulliparas.Birth 2011 Dec;38(4):
• Cochrane Database systemic trials 2012 have emphasised that
epidural analgesia had no statistically significant impact on the
risk of caesarean sections
HIGHER RISK OF VACUUM/FORCEPS EXTRACTION.

13. TIMING OF EPIDURAL-EARLY vs LATE
Wong CA et al,Risk of caesarean delivery in neuraxial analgesia given early vs late
in labour.N Engl J Med.2005;352:655-65.
NO DIFFERENCE IN LSCS RATES
(early-2cm,late-4-5cm)
• DOES NOT AFFECT BREAST FEEDING
• DOES NOT CAUSE MATERNAL PYREXIA

14. HUSBAND REFUSAL!!
• Any adult who is in a sound state of mind
to take a sensible decision can consent
for the procedure.
• DOCUMENT THE CONSENT PROPERLY.

15. KYBELE
• PROVIDES LABOUR ANALGESIA IN LOW
RESOURCE SETTINGS
• SINGLE SHOT SPINAL(180 min)
• 68 INSTITUTIONS,12 COUNTRIES,643
FACULTY

16. LOW-RESOURCE SETTINGS
• LIMITED KNOWLEDGE ,TRAINING
• FEAR
• SUPPLIES LACKING
• TOO FEW ANAESTHESIA PROVIDERS
• NO PERCEIVED NEED FOR SERVICE

17. ADVANTAGES /
TAKE HOME MESSAGES
• PAIN RELIEF IS A HUMAN RIGHT
• BETTER FETAL OXYGENATION
• BETTER BP CONTROL
• SHORTER LABOUR
• BETTER PATIENT SATISFACTION
• ANAESTHESIA FOR LSCS