DORSAL COLUMN FUNCTION AFTER EPIDURAL AND SPINAL BLOCKADE - IMPLICATIONS FOR THE SAFETY OF WALKING FOLLOWING LOW-DOSE REGIONAL ANALGESIA FOR LABOR

Walking after regional blockade for labour using low-dose combinations of bupivacaine and fentanyl is possible due to the maintenance of low er limb motor power. In order to investigate concerns that dorsal colu mn function, important in maintaining balance, is impaired after such techniques, clinical assessment of lower limb proprioception and vibra tion sense was evaluated in parturients after either low-dose epidural (n = 30) or spinal blockade (n = 30) for labour analgesia and compare d with spinal anaesthesia (n = 30) for elective Caesarean section usin g a larger total dose of local anaesthetic. Of the patients receiving low-dose regional labour analgesia 7% (n = 4) had abnormal dorsal colu mn function compared with 97% (n = 29) receiving spinal anaesthesia fo r Caesarean section (p < 0.001). All patients in the Caesarean section group developed lower limb motor weakness, compared with only 10% (n = 6) in the low-dose groups (p < 0.001). There were no significant dif ferences between the low-dose groups with respect to sensory block, mo tor block or dorsal column function. Overall, 90% of patients receivin g low-dose bupivacaine/fentanyl regional labour analgesia had both nor mal lower limb motor power and dorsal column function. Assessment of t hese parameters is recommended before allowing patients to walk after low-dose regional techniques for labour.