Continuous epidural anaesthesia with a low frequency of instrumental deliveries

The results of 204 cases of regional analgesia by means of continuous epidural block during labour and delivery are reported. The frequency of instrummental intervention using forceps or the vacuum extractor is low, less than 15% for primi- and multi-gravidas combined, although pathological conditions were recognized prior to blockade in almost one-third of the parturients. Moreover, the frequency of emergency Caesarean section has dropped significantly since epidural anaesthesia was introduced into the clinic. The 1 min Apgar scores of babies born to mothers given epidural anaesthesia are similar to those of babies born to mothers receiving conventional analgesic agents. The amount of blood lost by mothers given epidural anaesthesia was, on average, 15% less than in a control group. It is concluded that the essential feature of our technique of administering continuous regional analgesia is a selective block of small pain fibres with the deep tactile sensations largely intact, and the motor pathways virtually unaffected. This has been achieved using small doses of bupivacaine 0.25% concentration and meticulous observation of the individual patient.