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18 - Obstetrical anaesthesia

Published online by Cambridge University Press:  05 September 2009

Stephen Halpern
Affiliation:
University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
Ann Møller
Affiliation:
KAS Herlev, Copenhagen
Tom Pedersen
Affiliation:
Rigshospitalet, Copenhagen
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Summary

Neuraxial analgesia (epidural, and combined spinal–epidural techniques) effectively relieves labour pain. Whether or not these modalities affect progress of labour has been controversial. This chapter discusses the effect of neuraxial analgesia on caesarean section rates, instrumental delivery rates and the duration of labour. There is strong, homogeneous evidence to show that neuraxial analgesia does not increase the caesarean section rate. There is also strong, consistent evidence to show that there is an increase in the incidence of instrumental vaginal delivery in patients who have neuraxial analgesia. Further, there appears to be a dose–response relationship – parturients exposed to high concentrations of local anaesthetic are at higher risk for instrumental vaginal delivery than those exposed to low concentrations. While there appears to be a prolongation of the second stage of labour with neuraxial analgesia, these results are inconsistent and dependent on the obstetric protocol at a particular institution. In conclusion, neuraxial analgesia does not cause an increased incidence of caesarean section but may increase the incidence of instrumental vaginal delivery. This effect can be reduced by reducing the concentration of local anaesthetic. The effect on the length of first and second stage of labour is variable but is likely clinically unimportant.

Introduction

Since the introduction of anaesthesia to obstetric practice by James Young Simpson in 1847, there have been controversies concerning its use.

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Publisher: Cambridge University Press
Print publication year: 2006

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  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
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  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
Available formats
×