Control of pain during labour.

Too OFTEN, before she even meets the anaesthetist, the woman in labour has already experienced the greatest part of the pain associated with having her baby. She then receives an epidural block, a saddle block, or other form of anaesthetic for the final half hour or so of labour. The first stage is often a trying, unpleasant, and painful episode. In the past this has been dealt with relatively inadequately by the use of powerful depressants such as narcotics and ataractics, drugs which often do little good for the mother and some harm to the baby. A]though it has been known for more than forty years flaat a lumbar sympathetic block of T-10 to L-1 will result in painless uterine contractions, little has been done to take advantage of this fact to relieve the pain of the first stage of labour. Many techniques have appeared to block the outflow from T-10 to L-l: superior hypogastric plexus injection, bilateral T-11 to T-12 nerve root blockade, paravertebral blockade by either continuous or single injection, continuous caudal analgesia, continuous epidural anaesthesia, and the presently very popular paracervical block. In our efforts to provide first stage analgesia, we have found the injection of dilute, long-acting local anaesthetics in the lumbar epidural space, preferably by the continuous catheter technique, to be a most satisfactory method not only for maternal comfort but also for foetal and maternal safety. This paper describes the evolution of this method.