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Relief of Labor Pain by Regional Analgesia/Anesthesia

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Abstract

By far the most popular form of labor pain relief is regional analgesia. A number of techniques are possible for the different phases of labor and are listed in Table 9-1. This chapter will focus on central neuraxial techniques, including epidural and combined spinal-epidural analgesia.

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References

  1. Hogan H. Epidural anatomy: new observations. Can J Anaesth. 1998;45(5):R40–R44.

    Article  PubMed  CAS  Google Scholar 

  2. Beilin Y, Zahn J, Bernstein HH, Zucker-Pinchoff B, Zenzen WJ, Andres LA. Treatment of incomplete analgesia after placement of an epidural catheter and administration of local anesthetic for women in labor. Anesthesiology. 1998;88(6):1502–1506.

    Article  PubMed  CAS  Google Scholar 

  3. Segal S, Beach M, Eappen S. A multivariate model to predict the distance from the skin to the epidural space in an obstetric population. Reg Anesth. 1996;21(5):451–455.

    PubMed  CAS  Google Scholar 

  4. Bromage P, ed. Epidural Analgesia. Philadelphia: WB Sauders Co; 1978.

    Google Scholar 

  5. Bahar M, Chanimov M, Cohen ML, et al. Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection. Can J Anaesth. 2001;48(1):48–53.

    Article  PubMed  CAS  Google Scholar 

  6. Tsen LC. Neuraxial techniques for labor analgesia should be placed in the lateral position. Int J Obstet Anesth. 2008;17(2):146–149.

    Article  PubMed  Google Scholar 

  7. Polley LS. Neuraxial techniques for labor analgesia should be placed in the lateral position. Int J Obstet Anesth. 2008;17(2):149–152.

    Article  PubMed  CAS  Google Scholar 

  8. Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology. 1993;79(2):262–269.

    Article  PubMed  CAS  Google Scholar 

  9. D’Angelo R, Foss ML, Livesay CH. A comparison of multiport and uniport epidural catheters in laboring patients. Anesth Analg. 1997;84(6):1276–1279.

    Article  PubMed  Google Scholar 

  10. Dickson MA, Moores C, McClure JH. Comparison of single, end-holed and multi-orifice extradural catheters when used for continuous infusion of local anaesthetic during labour. Br J Anaesth. 1997;79(3):297–300.

    PubMed  CAS  Google Scholar 

  11. Segal S, Eappen S, Datta S. Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery. J Clin Anesth. 1997;9(2):109–112.

    Article  PubMed  CAS  Google Scholar 

  12. Beilin Y, Bernstein HH, Zucker-Pinchoff B. The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space. Anesth Analg. 1995;81(2):301–304.

    Article  PubMed  CAS  Google Scholar 

  13. D‘Angelo R, Berkebile BL, Gerancher JC. Prospective examination of epidural catheter insertion. Anesthesiology. 1996;84(1):88–93.

    Article  PubMed  Google Scholar 

  14. Jaime F, Mandell GL, Vallejo MC, Ramanathan S. Uniport soft-tip, open-ended catheters versus multiport firm-tipped close-ended catheters for epidural labor analgesia: a quality assurance study. J Clin Anesth. 2000;12(2):89–93.

    Article  PubMed  CAS  Google Scholar 

  15. Hamilton CL, Riley ET, Cohen SE. Changes in the position of epidural catheters associated with patient movement. Anesthesiology. 1997;86(4):778–784, discussion 729A.

    Article  PubMed  CAS  Google Scholar 

  16. Moore DC, Batra MS. The components of an effective test dose prior to epidural block. Anesthesiology. 1981;55(6):693–696.

    Article  PubMed  CAS  Google Scholar 

  17. Cartwright PD, McCarroll SM, Antzaka C. Maternal heart rate changes with a plain epidural test dose. Anesthesiology. 1986;65(2):226–228.

    Article  PubMed  CAS  Google Scholar 

  18. Leighton BL, Norris MC, Sosis M. Limitations of an epinephrine epidural anesthesia test dose in laboring patients (abstract). Anesthesiology. 1986;65:403.

    Article  Google Scholar 

  19. Leighton BL, Norris MC. Epidural test dose and intravascular injection in obstetrics: sensitivity, specificity. Anesth Analg. 1993;76(5):1174–1175.

    Article  PubMed  CAS  Google Scholar 

  20. Abraham RA, Harris AP, Maxwell LG, Kaplow S. The efficacy of 1.5% lidocaine with 7.5% dextrose and epinephrine as an epidural test dose for obstetrics. Anesthesiology. 1986;64(1):116–119.

    Article  PubMed  CAS  Google Scholar 

  21. Leighton BL, Norris MC, DeSimone CA, Rosko T, Gross JB. The air test as a clinically useful indicator of intravenously placed epidural catheters. Anesthesiology. 1990;73(4):610–613.

    Article  PubMed  CAS  Google Scholar 

  22. Guay J. The epidural test dose: a review. Anesth Analg. 2006;102(3):921–929.

    Article  PubMed  Google Scholar 

  23. Popitz-Bergez F, Datta S, Ostheimer GW. Intravascular epinephrine may not increase heart rate in patients receiving metoprolol. Anesthesiology. 1988;68(5):815–816.

    Article  PubMed  CAS  Google Scholar 

  24. Atienzar MC, Palanca JM, Torres F, Borras R, Gil S, Esteve I. A randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia. Int J Obstet Anesth. 2008;17(2):106–111.

    Article  PubMed  CAS  Google Scholar 

  25. Beilin Y, Guinn NR, Bernstein HH, Zahn J, Hossain S, Bodian CA. Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine. Anesth Analg. 2007;105(3):756–763.

    Article  PubMed  CAS  Google Scholar 

  26. Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology. 1999;90(4):944–950.

    Article  PubMed  CAS  Google Scholar 

  27. Scott DB, Walker LR. Administration of continuous epidural analgesia. Anaesthesia. 1963;18:82–83.

    Article  PubMed  CAS  Google Scholar 

  28. Smedstad KG, Morison DH. A comparative study of continuous and intermittent epidural analgesia for labour and delivery. Can J Anaesth. 1988;35(3 Pt 1):234–241.

    Article  PubMed  CAS  Google Scholar 

  29. Chen SH, Liou SC, Hung CT, et al. Comparison of patient-controlled epidural analgesia and continuous epidural infusion for labor analgesia. Chang Gung Med J. 2006;29(6):576–582.

    PubMed  Google Scholar 

  30. Okutomi T, Saito M, Mochizuki J, Amano K, Hoka S. A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain. Int J Obstet Anesth. 2008.

    Google Scholar 

  31. Celleno D, Capogna G. Epidural fentanyl plus bupivacaine 0.125 per cent for labour: analgesic effects. Can J Anaesth. 1988;35(4):375–378.

    Article  PubMed  CAS  Google Scholar 

  32. Skerman J, Thompson B, Goldstein M. Combined continuous epidural fentanyl and bupivacaine in labor: a randomized study. Anesthesiology. 1985;63:450.

    Article  Google Scholar 

  33. Chestnut DH, Owen CL, Bates JN, Ostman LG, Choi WW, Geiger MW. Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology. 1988;68(5):754–759.

    Article  PubMed  CAS  Google Scholar 

  34. Phillips G. Continuous infusion epidural analgesia in labor: the effect of adding sufentanil to 0.125% bupivacaine. Anesth Analg. 1988;67(5):462–465.

    Article  PubMed  CAS  Google Scholar 

  35. Tsen LC, Thue B, Datta S, Segal S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology. 1999;91(4):920–925.

    Article  PubMed  CAS  Google Scholar 

  36. Wong CA, Scavone BM, Peaceman AM, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352(7):655–665.

    Article  PubMed  CAS  Google Scholar 

  37. Borgeat A, Stirnemann HR. Ondansetron is effective to treat spinal or epidural morphine-induced pruritus. Anesthesiology. 1999;90(2):432–436.

    Article  PubMed  CAS  Google Scholar 

  38. Friedlander JD, Fox HE, Cain CF, Dominguez CL, Smiley RM. Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labor. Reg Anesth. 1997;22(4):378–381.

    Article  PubMed  CAS  Google Scholar 

  39. Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg. 1998;87(4):864–869.

    Article  PubMed  CAS  Google Scholar 

  40. Segal S, Wang SY. The effect of maternal catecholamines on the caliber of gravid uterine microvessels. Anesth Analg. 2008;106(3):888–892, table of contents.

    Article  PubMed  CAS  Google Scholar 

  41. Sharma SK, Philip J, Whitten CW, Padakandla UB, Landers DF. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology. 1999;90(2):385–390.

    Article  PubMed  CAS  Google Scholar 

  42. Orlikowski CE, Rocke DA, Murray WB, et al. Thromboelastography changes in pre-eclampsia and eclampsia. Br J Anaesth. 1996;77(2):157–161.

    PubMed  CAS  Google Scholar 

  43. Scott DB, Hibbard BM. Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth. 1990;64(5):537–541.

    Article  PubMed  CAS  Google Scholar 

  44. Donaldson J. Neurology of Pregnancy. 2nd ed. London: W.B. Saunders; 1989.

    Google Scholar 

  45. Ong BY, Cohen MM, Esmail A, Cumming M, Kozody R, Palahniuk RJ. Paresthesias and motor dysfunction after labor and delivery. Anesth Analg. 1987;66(1):18–22.

    Article  PubMed  CAS  Google Scholar 

  46. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87(3):479–486.

    Article  PubMed  CAS  Google Scholar 

  47. Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care. 1983;11(1):4–15.

    PubMed  CAS  Google Scholar 

  48. Sprigge JS, Harper SJ. Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. Anaesthesia. 2008;63(1):36–43.

    Article  PubMed  CAS  Google Scholar 

  49. Craft JB, Epstein BS, Coakley CS. Prophylaxis of dural-puncture headache with epidural saline. Anesth Analg. 1973;52(2):228–231.

    Article  PubMed  CAS  Google Scholar 

  50. Smith BE. Prophylaxis of epidural wet tap headache (abstract). American Society of Anesthesiologists, San Fancisco. 1979:119.

    Google Scholar 

  51. Crawford JS. The prevention of headache consequent upon dural puncture. Br J Anaesth. 1972;44(6):598–600.

    Article  PubMed  CAS  Google Scholar 

  52. Colonna-Romano P, Shapiro BE. Unintentional dural puncture and prophylactic epidural blood patch in obstetrics. Anesth Analg. 1989;69(4):522–523.

    Article  PubMed  CAS  Google Scholar 

  53. Scavone BM, Wong CA, Sullivan JT, Yaghmour E, Sherwani SS, McCarthy RJ. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Anesthesiology. 2004;101(6):1422–1427.

    Article  PubMed  Google Scholar 

  54. Szeinfeld M, Ihmeidan IH, Moser MM, Machado R, Klose KJ, Serafini AN. Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology. 1986;64(6):820–822.

    Article  PubMed  CAS  Google Scholar 

  55. Gewirtz EC, Costin M, Marx G. Cortical vein thrombosis may mimic postdural puncture headache. Reg Anaesth. 1987;12:188.

    Google Scholar 

  56. Al-metwalli RR. Epidural morphine injections for prevention of post dural puncture headache. Anaesthesia. 2008;63(8):847–850.

    Article  PubMed  CAS  Google Scholar 

  57. Noyan Ashraf MA, Sadeghi A, Azarbakht Z, Salehi S, Hamediseresht E. Evaluation of intravenous hydrocortisone in reducing headache after spinal anesthesia: a double blind controlled clinical study [corrected]. Middle East J Anesthesiol. 2007;19(2):415–422.

    PubMed  CAS  Google Scholar 

  58. Ghai A, Wadhera R. Adrenocorticotrophic hormone – is a single dose sufficient for post-dural puncture headache? Acta Anaesthesiol Scand. 2007;51(2):266.

    Article  PubMed  CAS  Google Scholar 

  59. Skaredoff MN, Datta S. Horner’s syndrome during epidural anaesthesia for elective caesarean section. Can Anaesth Soc J. 1981;28(1):82–85.

    Article  PubMed  CAS  Google Scholar 

  60. Breen TW, Ransil BJ, Groves PA, Oriol NE. Factors associated with back pain after childbirth. Anesthesiology. 1994;81(1):29–34.

    Article  PubMed  CAS  Google Scholar 

  61. Macarthur AJ, Macarthur C, Weeks SK. Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study. Anesth Analg. 1997;85(5):1066–1070.

    Article  PubMed  CAS  Google Scholar 

  62. Hill EC. Maternal obstetric paralysis. Am J Obstet Gynecol. 1962;83:1452–1460.

    PubMed  CAS  Google Scholar 

  63. Cole JT. Maternal obstetric paralysis. Am J Obstet Gynecol. 1946;52:372.

    PubMed  CAS  Google Scholar 

  64. Bromage PR. An evaluation of bupivacaine in epidural analgesia for obstetrics. Can Anaesth Soc J. 1969;16(1):46–56.

    Article  PubMed  CAS  Google Scholar 

  65. Ravindran RS, Bond VK, Tasch MD, Gupta CD, Luerssen TG. Prolonged neural blockade following regional analgesia with 2-chloroprocaine. Anesth Analg. 1980;59(6):447–451.

    Article  PubMed  CAS  Google Scholar 

  66. Gissen AJ, Datta S, Lampbert D. The chloroprocaine controversy. I. A hypothesis to explain the neural complications of chloroprocaine epidural. . Reg Anaesth. 1984;9:124.

    CAS  Google Scholar 

  67. Gissen AJ, Datta S, Lampbert D. The chloroprocaine controversy. II. Is chloroprocaine neurotoxic? Reg Anaesth. 1984;9:135.

    CAS  Google Scholar 

  68. Taniguchi M, Bollen AW, Drasner K. Sodium bisulfite: scapegoat for chloroprocaine neurotoxicity? Anesthesiology. 2004;100(1):85–91.

    Article  PubMed  CAS  Google Scholar 

  69. Sell A, Tein T, Pitkanen M. Spinal 2-chloroprocaine: effective dose for ambulatory surgery. Acta Anaesthesiol Scand. 2008;52(5):695–699.

    Article  PubMed  CAS  Google Scholar 

  70. Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72(3):275–281.

    Article  PubMed  CAS  Google Scholar 

  71. Arkoosh VA, Palmer CM, Yun EM, et al. A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia. Anesthesiology. 2008;108(2):286–298.

    Article  PubMed  CAS  Google Scholar 

  72. Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg. 1993;76(5):1154–1157.

    Article  PubMed  CAS  Google Scholar 

  73. Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, et al. Transient neurologic symptoms after spinal anesthesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology. 1998;88(3):629–633.

    Article  PubMed  CAS  Google Scholar 

  74. Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology. 1996;84(6):1361–1367.

    Article  PubMed  CAS  Google Scholar 

  75. Pollock JE, Liu SS, Neal JM, Stephenson CA. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology. 1999;90(2):445–450.

    Article  PubMed  CAS  Google Scholar 

  76. Pollock JE, Burkhead D, Neal JM, et al. Spinal nerve function in five volunteers experiencing transient neurologic symptoms after lidocaine subarachnoid anesthesia. Anesth Analg. 2000;90(3):658–665.

    Article  PubMed  CAS  Google Scholar 

  77. Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311–323.

    PubMed  Google Scholar 

  78. Carp H, Bailey S. The association between meningitis and dural puncture in bacteremic rats. Anesthesiology. 1992;76(5):739–742.

    Article  PubMed  CAS  Google Scholar 

  79. Abouleish E. Pain Control in Obstetrics. Philadelphia: JB Lippincott; 1977:261.

    Google Scholar 

  80. Carbaat PA, Van Crevel H. Lumbar puncture headache. Controlled study on the preventive effect of 24 hours bed rest. Lancet 1981;2:1133–1135.

    Google Scholar 

  81. Munnur U, Suresh MS. Backache, headache, and neurologic deficit after regional anesthesia. Anesthesiol Clin North America. 2003;21(1):71–86.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Brigham & Women’s Hospital, Boston, MA, USA

    Sanjay Datta (Professor of Anesthesia), Bhavani Shankar Kodali (Associate Professor of Anesthesia) & Scott Segal (Associate Professor of Anesthesia)

  2. Harvard Medical School, Boston, MA, USA

    Sanjay Datta (Professor of Anesthesia), Bhavani Shankar Kodali (Associate Professor of Anesthesia) & Scott Segal (Associate Professor of Anesthesia)

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  1. Sanjay Datta
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  2. Bhavani Shankar Kodali
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  3. Scott Segal
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Correspondence to Sanjay Datta .

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Datta, S., Kodali, B.S., Segal, S. (2010). Relief of Labor Pain by Regional Analgesia/Anesthesia. In: Obstetric Anesthesia Handbook. Springer, New York, NY. https://doi.org/10.1007/978-0-387-88602-2_9

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  • DOI: https://doi.org/10.1007/978-0-387-88602-2_9

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