Hazards Of Epidural• Analgesia During Labor

Abstract

Epidural analgesia is a commonly employed technique of providing pain relief during labor. The epidural space is a potential space lying between the dura mater and vertebral canal. The epidural needle can be introduced at the 2ed or 3ed lumbar space either by midline approach or paramedian approach. Methods for identifying the epidural space fall into two broad categories, the loss of (resistance technique) and the (hanging drop) technique. An epidural catheter can be introduced into epidural needle and can be used for either top-up doses or for continuous epidural analgesia. Fluctuations in pain control are an almost inevitable result of the intermittent top-up technique of epidural analgesia. Delays between the request for a top­ up and the onset of analgesia are inevitable. Infusions overcome this to a large degree, and the infusion rate can be altered to introduce an element of fine­ tuning and provide a level of block that suits the patient. There is a less motor block permitting the parturient greater mobility in bed. Pelvic muscle tone is maintained with decreased incidence of mal position. Indications to initiate epidural block for labor and delivery is pain during

active labor and for a trial of labor. In the high-risk pregnancy initiating early and maintaining a solid sensory level protects both mother and fetus against stress of pain associated with labor and allows inunediate start of an operative delivery by either the abdominal or vaginal route. An epidural anesthesia must be done safely in an area adequately equipped for treating complications ranging from mild hypotension to cardiac arrest.