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Epidural analgesia in labour

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

In the first stage of labour an epidural analgesia is required to block T8-L5. It should include a block of S2-S4 in the second stage of labour.

Epidural analgesia is indicated in labour for:

  • maternal distress as a result of painful uterine contractions which are not being adequately controlled by simple analgesia e.g. pethidine, nitrous oxide
  • anaesthesia for a forceps delivery or vacuum extraction
  • hypertension: pregnancy-induced and chronic. Epidural analgesia is helpful in lowering blood pressure as well as reducing the amount of sedation required
  • caesarian section
  • if desired by the woman in labour (1)

NICE (1) note:

  • women in labour who desire regional analgesia should not be denied it, including women in severe pain in the latent first stage of labour
  • either epidural or combined spinal-epidural analgesia is recommended for establishing regional analgesia in labour
  • if rapid analgesia is required, combined spinal-epidural analgesia is recommended
  • it is recommended that combined spinal-epidural analgesia is established with bupivacaine and fentanyl
  • it is recommended that epidural analgesia is established with a low-concentration local anaesthetic and opioid solution with, for example, 10-15 ml of 0.0625-0.1% bupivacaine with 1-2 micrograms per ml fentanyl. The initial dose of local anaesthetic plus opioid is essentially a test dose and as such should be administered cautiously to ensure that inadvertent intrathecal injection has not occurred
  • low-concentration local anaesthetic and opioid solutions (0.0625-0.1% bupivacaine or equivalent combined with 2.0 micrograms per ml fentanyl) are recommended for maintaining epidural analgesia in labour
  • high concentrations of local anaesthetic solutions (0.25% or above of bupivacaine or equivalent) should not be used routinely for either establishing or maintaining epidural analgesia
  • either patient-controlled epidural analgesia or intermittent bolus given by healthcare professionals are the preferred modes of administration for maintenance of epidural analgesia

Reference:

  1. NICE (September 2007).Intrapartum care

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