EPIDURAL ANALGESIA IN OBSTETRICS

Until today, the use of epidural analgesia in obstetrics still remains controversial. In the opinion of many obstetricians the use of an epi dural for a healthy laboring parturient is not necessary and can lead to potentially harmful side effects. However, painful labor leads to a maternal stress reaction with the release of epinephrine and norepine phrine. The resulting vasoconstriction of uterine arteries can induce fetal asphyxia in an otherwise healthy fetus or can aggravate asphyxia in already compromised fetusses. Several studies show that epidural a nalgesia can attenuate the maternal stress reaction and thereby improv e maternal and fetal well-being,as long as precautions are taken. The avoidance of maternal hypotension with sufficient volume preload with lactated Ringer's solution or colloids, and decreasing. the concentrat ion of local anaesthetics by adding opioids will prevent an increase i n instrumental deliveries. With the use of patient-controlled epidural analgesia (PCEA) the amount of local anaesthetics can even further be reduced.