Regional Analgesia-Anesthesia

Abstract

In the past three decades there has been an impressive progressive increase in the use of regional analgesia-anesthesia during labor and for delivery, not only in the United States but in many other countries where heretofore pharmacologic obstetric anesthesia has been avoided. The most common techniques used are 1. paracervical-pudendal blocks, 2. subarachnoid (saddle) block, 3. continuous epidural block and 4. continuous caudal block. The reason for the widespread popularity of this method is that when each of these techniques is properly applied, it affords the following significant advantages: 1. In contrast to narcotics regional analgesia produces complete relief of pain; 2. the hazard of pulmonary aspiration of gastric contents during general anesthesia is virtually eliminated; 3. provided no complications occur, regional anesthesia causes no maternal or neonatal depression; 4. administered at the proper time, it does not impede the progress of labor; 5. continuous techniques can be extended for the delivery and may even be modified for cesarean section if this becomes necessary; 6. regional analgesia permits the mother to remain awake during labor and delivery so that she can experience the pleasure of actively participating in the birth of her child. However, regional analgesia does have certain disadvantages: 1. It requires greater skill to administer than do systemic drugs or inhalation agents; 2. technical failures occur, even in experienced hands; 3. certain techniques produce side effects which, if not properly treated, can progress to complications; 4. techniques that produce perineal muscle paralysis interfere with the mechanism of internal rotation and increase the incidence of persistent posterior positions; 5. these procedures can only be carried out in the hospital.