An improved method of epidural analgesia with reduced instrumental delivery rate. 1975

A Matouskova, and O Dottori, and L Forssman, and L Victorin

A detailed study on a modified technique of epidural analgesia (EDA) for pain relief in obstetrics has been performed. The aim of the modifications was to reduce the number of instrumental deliveries and at the same time to make the delivery as smooth as possible for the baby. This was achieved by the use of an anaesthetic with a favourable ratio between neonatal and maternal plasma levels (Bupivacaine) in low concentration (0.25%). A special technique of injection enabled us to limit the extent of the blockade. An epidural catheter was inserted between L2 and L3 and moved upwards 20 cm into the epidural space. 8-10 ml of the solution was then injected after a test dose. The blockade was continued by the repeated injection of smaller doses. As judged by the skin anaesthetic zones and by obstetric examinations, the patient was gradually positioned, during labour, from supine to half-sitting. The catheter was withdrawn at the end of the first stage of labour so that the lower sacral segments could be blocked. A group of 100 patients treated with the technique described was followed. The number of instrumental deliveries in the present series (15%) was significantly lower in similar series reported in the literature. The group of 100 patients treated with modified EDA was also compared with 100 control patients who received only conventional treatment without EDA. There was no differences in the number of abnormal presentations, while the number of caesarean sections and cases of atonic post-partum bleeding was insignificantly lower in the EDA group. The difference in the number of instrumental deliveries-although somewhat higher in the EDA group-was not statistically significant. The total length of labour was prolonged in the EDA group but EDA was not necessarily responsible for this undesired effect. The clinical status of the babies was found to be better after EDA than in control group, as judged from Apgar score. Furthermore, fetal bradycardia was significantly reduced with EDA. It is concluded that EDA, as used in this study, not only is a preferable way of achieving pain relif in the mother but also offers a means of facilitating the birth process for the infant, reducing the incidence of pre- and post-natal asphyxia.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007743 Labor, Obstetric The repetitive uterine contraction during childbirth which is associated with the progressive dilation of the uterine cervix (CERVIX UTERI). Successful labor results in the expulsion of the FETUS and PLACENTA. Obstetric labor can be spontaneous or induced (LABOR, INDUCED). Obstetric Labor
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002045 Bupivacaine A widely used local anesthetic agent. 1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide,Bupivacain Janapharm,Bupivacain-RPR,Bupivacaina Braun,Bupivacaine Anhydrous,Bupivacaine Carbonate,Bupivacaine Hydrochloride,Bupivacaine Monohydrochloride, Monohydrate,Buvacaina,Carbostesin,Dolanaest,Marcain,Marcaine,Sensorcaine,Svedocain Sin Vasoconstr,Bupivacain RPR
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000767 Anesthesia, Epidural Procedure in which an anesthetic is injected into the epidural space. Anesthesia, Extradural,Anesthesia, Peridural,Epidural Anesthesia,Anesthesias, Epidural,Anesthesias, Extradural,Anesthesias, Peridural,Epidural Anesthesias,Extradural Anesthesia,Extradural Anesthesias,Peridural Anesthesia,Peridural Anesthesias
D000773 Anesthesia, Obstetrical A variety of anesthetic methods such as EPIDURAL ANESTHESIA used to control the pain of childbirth. Anesthesia, Gynecological,Anesthesia, Obstetric,Gynecologic Anesthesia,Paracervical Block,Anesthesia, Gynecologic,Block, Paracervical,Blocks, Paracervical,Gynecological Anesthesia,Obstetric Anesthesia,Obstetrical Anesthesia,Paracervical Blocks
D036861 Delivery, Obstetric Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions. Obstetric Delivery,Deliveries, Obstetric,Obstetric Deliveries

Related Publications

A Matouskova, and O Dottori, and L Forssman, and L Victorin
March 1984, Anaesthesia,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
August 1984, Anaesthesia,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
January 2001, BJOG : an international journal of obstetrics and gynaecology,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
January 2015, Medicina (Kaunas, Lithuania),
A Matouskova, and O Dottori, and L Forssman, and L Victorin
November 1987, Obstetrics and gynecology,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
November 2001, Revista espanola de anestesiologia y reanimacion,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
May 1987, Obstetrics and gynecology,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
January 1977, British medical journal,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
September 1988, Anaesthesia,
A Matouskova, and O Dottori, and L Forssman, and L Victorin
February 1989, Anaesthesia,
Copied contents to your clipboard!