Canadian Journal of Anesthesia, Vol 9, 143-152, Copyright © 1962 by Canadian Anesthesiologists' Society

Continuous Epidural Analgesia for Labour and Delivery

¹ Department of Anaesthesia, University of Western Ontario, and Victoria Hospital and St. Joseph's Hospital, London, Ontario

A method of producing analgesia by means of a continuous epidural technique employing a single catheter in the upper lumbar epidural space was used in 213 obstetrical cases. In most cases the epidural analgesia was begun at the time when the patient would have required analgesic medicaton. During the first stage of labour a small volume of local anaesthesic agent was used to block the sensory nerve supply of the uterus; a large volume provided adequate anaesthesia of the birth canal for delivery, usually by forceps. With this method good results were obtained in 85 % for analgesia in labour and in 80 % of those cases for delivery. The high incidence of inadequate results was mainly due to errors in the management of the block, and considerable improvement is possible by better coverage with trained anaesthetists, Failures and complications have been discussed. In over 80 % of our cases the epidural analgesic was maintained for less than 10 hours; the longest case lasted 26 hours.

An attempt was made to evaluate the effect of continuous epidural analgesia on the duration of labour and no significant difference between these cases and the tolal maternity cases of our hospital was found. It is felt, however, that this comparison does not do justice to the technique, since our series was influenced by a number of patients with prolonged labour prior to the epidural analgesia; this selection also explains the higher incidence of Caesarian section.