[Para-spinal analgesia in obstetrics]

The use of regional analgesia and anesthesia in obstetrics has been established since the end of the 19th century. According to an agreement between German societies of anesthesiologists and obstetricians, regional anesthesia may be performed by both anesthesiologists and obstetricians under certain preconditions. At the RWTH Aachen hospital, the responsibility for different anesthetic techniques is divided between anesthesiologists and obstetricians in order to reduce legal risks. Caudal anesthesia is done by obstetricians, whereas anesthesiologists perform lumbar epidural anesthesia. A retrospective study over three years has shown comparable results. Lumbar epidural catheters were preferred in primiparous women, while caudal anesthesia was used more often in multiparous women. One-minute Apgar values as well as postpartum fetal arterial blood gas analyses did not differ significantly in both groups. The failure rate of caudal anesthesia was higher than that of lumbar epidural anesthesia. Blood pressure falls exceeding 20 percent of baseline were only seen in the epidural group (incidence 0.9 to 1.5 percent). The incidence of fetal bradycardia and the overall complication rate were similar in both groups.