Lumbar epidural analgesia in hypertensive patients during labour

Continuous lumbar epidural analgesia (L.E.A.) is considered to be the most effective technique for providing pain relief during labour and delivery. A prospective randomized study of 52 patients with pre-eclamptic toxemia in labour was carried out to investigate various aspects of the use of L.E.A. in view of the considerable disagreement concerning its effect. The results were compared to a control group (n = 52) receiving i.v. infusion of Hydralazine (Apresoline) and MgSO4 according to Zuspan recommendations. The results were evaluated statistically. The incidence of neonatal jaundice was higher in the control group (P less than 0.005). Maternal postpartum complications were similar in both groups. There were fewer forceps deliveries in the control group (P less than 0.05). The decrease in systolic BP after L.E.A. is well documented up to 120 min after the first injection of Marcaine (P less than 0.001-0.025), while after 120 min, by which time the Marcaine effect has finished, the systolic BP rises again (time for topping up). The decrease in the average diastolic BP as compared to the control group is statistically significant (P less than 0.001-0.01) until 180 min after initiation of the L.E.A. After that, the average diastolic BP rises again, unless Marcaine is topped up. Our results favour L.E.A. as the obstetric analgesic method of choice in cases of severe pre-eclampsia.