The anesthetic management of uncomplicated labor and delivery using the segmental technique of continuous lumbar epidural analgesia.

The safety, advantages, disadvantages and anesthetic agents used in the segmental technique of continous lumbar epidural analgesia for pain relief during labor and delivery are discussed in this article. The author describes the anesthetic management of an uncomplicated labor and vaginal delivery. Upon reading the Joint Commission on Accredita-tion of Hospitals' manual, it becomes obvious that the standard for anesthesia care available for the obstetrical service shall be equal to the standard available for the surgical service.' As a result, there is an increasing demand by obstetricians for anesthetists who are fully trained in all aspects of ob-stetrical anesthesia. The anesthesia armamentarium for obstetrical anesthesia is wide ranging; paracer-vical block; caudal and lumbar epidural block, both single injection and continous technique; spinal block; inhalation analgesia; and general anesthesia. This article focuses on continous lumbar epi-dural (CLE) analgesia using the segmental technique. The segmental technique refers to the practice of blocking selected spinal nerves during the different stages of labor. Spinal nerves from T1o to L1 are blocked in the first stage of labor and spinal nerves S2-5 are blocked in the second stage of labor. The safety of CLE for both the mother and fetus has been well documented. 2-6 In a protracted, 372 painful labor, CLE frequently allows uterine contractions to become more coordinated. It can reduce the incidence of metabolic acidosis and prevent decreases in uterine blood flow resulting from high endogenous catecholamines. 7 CLE is a technique that allows excellent control of both the intensity of analgesia and the area of analgesia coverage. This safety and precision, when coupled with extended time intervals, makes CLE an excellent choice for analgesia in labor and delivery. There is a subtle difference in administering anesthesia for labor that has to be appreciated if misunderstanding and conflict between obstetri-cian and anesthetist is to be avoided. This difference is that the goal is minimal sensory analgesia, not profound anesthesia as administered during surgery. Sensory analgesia allows the mother to participate in labor. It does not increase the incidence of transverse arrest, posterior presentations, and forceps applications.' 9 The laboring mother and expectant father want to participate in the birthing process. They often have been to prenatal classes and are aware of media reports extolling the benefits of natural childbirth. It is not proper for anesthetists to administer anesthesia to the degree where this desire is thwarted. With properly administered CLE, the laboring …