Abstract
Epidural analgesia is considered the most effective method of pain relief during labor. Advances, in both drugs and equipment, have meant a great improvement in its safety and effectiveness. However, epidural analgesia may fail in its main objective, which is to provide effective analgesia or anesthesia and some of these failures are due to technical problems.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Hermanides J, Hollmann MW, Stevens MF, Lirk P (2012) Failed epidural: causes and management. Br J Anaesth 109:144–154
Birnbach DJ, Ranasinghe JS (2008) Anesthesia complications in the birthplace: is the neuraxial block always to blame? Clin Perinatol 35:35–52
Eappen S, Blinn A, Segal S (1998) Incidence of epidural catheter replacement in parturients: a retrospective chart review. Int J Obstet Anesth 7:220–225
Polley L, Columb MO, Naughton N et al (2002) Effect of epinephrine on the minimum local analgesic concentration of epidural bupivacaine in labor. Anesthesiology 96:1123–1128
Columb MO, Lyons G (1995) Determination of minimum local anaesthetic concentration of epidural bupivacaine and lidocaine in labor. Anesth Analg 81:833–837
Paech MJ, Godkin R, Webster S (1998) Complications of obstetric epidural analgesia and anesthesia: a prospective analysis of 10,995 cases. Int J Obstet Anesth 7:5–11
Beilin Y, Bernstein H, Zucker-Pinchoff B (1995) The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space. Anesth Analg 81:301–304
Pan PH, Bogard TD, Owen MD (2004) Incidence and characteristics of failures in obstetrical neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 13:227–233
Crawford JS (1972) The second thousand epidural blocks in an obstetric hospital practice. Br J Anaesth 44:1277–1286
Agaram R, Douglas MJ, McTaggart RA et al (2009) Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors. Int J Obstet Anesth 18:10–14
Lee RA, van Zundert AA, Botha CP et al (2010) The anatomy of the thoracic spinal canal in different postures: a magnetic resonance imaging investigation. Reg Anesth Pain Med 35:364–369
Coppejans HC, Hendrickx E, Goossens J et al (2006) The sitting versus right lateral position during combined spinal–epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg 102:243–247
Bahar M, Chanimov M, Cohen ML (2004) The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients. Can J Anaesth 51:577–580
Griffin RM, Forum SRP (1984) A comparison between the midline and paramedian approaches to the extradural space. Anaesthesia 39:584–586
Podder S, Kumar N, Yaddanapudi LN, Chari P (2004) Paramedian lumbar epidural catheter insertion with patients in the sitting position is equally successful in the flexed and unflexed spine. Anesth Analg 99:1829–1832
Beilin Y, Arnold I, Telfeyan C et al (2000) Quality of analgesia when air versus saline is used for identification of the epidural space in the parturient. Reg Anesth Pain Med 25:596–599
Schier R, Guerra D, Aguilar J et al (2009) Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance. Anesth Analg 109:2012–2021
Balki M, Lee Y, Halpern S, Carvalho JC (2009) Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg 108:1876–1881
Clark MX, O’Hare K, Gorringe J, Oh T (2001) The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trial. Anaesthesia 56:865–870
Morrison LMM, Buchan AS (1990) Comparison of complications associated with single-holed and multiholed extradural catheters. Br J Anaesth 64:183–185
Lin CC (2003) Air-locked epidural filter. Anesthesiology 99:515
Miro M, Guasch E, Gilsanz F (2008) Comparison of epidural analgesia with combined spinal-epidural analgesia for labor: a retrospective study of 6497 cases. Int J Obstet Anesth 17:15–19
Beilin Y, Zahn J, Bernstein H et al (1998) Treatment of incomplete analgesia after placement of an epidural catheter and administration of local anesthetic for women in labor. Anesthesiology 88:1502–1506
Wong C (2009) Epidural and spinal analgesia/anesthesia for labor and vaginal delivery. In: Chestnut’s obstetric anesthesia principles and practice. Mosby-Elsevier, Philadelphia, PA, pp 430–492
Orbach-Zinger S, Avramovich A, Ilgiaeva N et al (2006) Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand 50:1014–1018
Vallejo MC, Phelps AL, Singh S, Orebaugh SL, Sah N (2010) Ultrasound decreases the failed labor epidural rate in resident trainees. Int J Obstet Anesth 19:373–378
Capogna G, Stirparo S (2013) Techniques for the maintenance of epidural labour analgesia. Curr Opin Anaesthesiol 26:261–267
Collier CB (1996) Why obstetric epidurals fail: a study of epidurograms. Int J Obstet Anesth 5:19–31
Hamilton CL, Riley E, Cohen S (1997) Changes in the position of epidural catheters associated with patient movement. Anesthesiology 86:778–784
Blomberg R (1986) The dorsomedian connective tissueband in the lumbar epidural space of humans. An anatomical study using epiduroscopy in autoscopy cases. Anesth Analg 65:747–752
Asato F, Goto F (1996) Radiographic findings of unilateral epidural block. Anesth Analg 83:519–522
Heesen M, Van de Velde M, Klöhr S et al (2014) Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia 69:64–71
Scott DB, Tunstall ME (1995) Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study. Int J Obstet Anesth 4:133–139
Jenkins JG (2005) Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals. Int J Obstet Anesth 14:37–42
Collier CB (2003) Accidental subdural injection during obstetric epidural block, it’s commoner than you think! Epidurogram evidence. Int J Obstet Anesth 12:201
Collier C (1982) Total spinal or massive subdural block? Anaesth Intensive Care 10:92–93
Lubenow T, Keh-Wong E, Kristof K et al (1988) Inadvertent subdural injection: a complication of an epidural block. Anesth Analg 67:175–179
Hoftman N, Ferrante M (2009) Diagnosis of unintentional subdural anesthesia/analgesia: analyzing radiographically proven cases to define the clinical entity and to develop a diagnostic algorithm. Reg Anesth Pain Med 34:12–16
Hess PE, Pratt SD, Lucas TP et al (2001) Predictors of breakthrough pain during labor epidural analgesia. Anesth Analg 93:414–418
Loubert C, Hinova A, Fernando R (2011) Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years. Anaesthesia 66:191–212
van der Vyver M, Halpern S, Joseph G (2002) Patient controlled epidural analgesia versus continuous infusión for labour analgesia: a meta-analysis. Br J Anaesth 89:459–465
Hawkins JL, Arens JF, Bucklin BA et al (2007) Practice guidelines for obstetric anesthesia: an updated report by the American society of anesthesiologists task force on obstetric anesthesia. Anesthesiology 106:843–863
Hogan Q (2002) Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med 27:150–156
Wong CA, Ratliff JT, Sullivan JT et al (2006) A randomised comparison of programmed intermittent epidural bolus with continuous epidural infusión for labor analgesia. Anesth Analg 102:904–909
Halpern SH, Carvalho B (2009) Patient-controlled epidural analgesia for labor. Anesth Analg 108:921–928
Stratmann G, Gambling DR, Moeller-Bertram T et al (2005) A randomized comparison of a five-minute versus fifteen-minute lockout interval for PCEA during labor. Int J Obstet Anesth 14:200–207
Sia AT, Lim Y, Ocampo CE (2006) Computer-integrated patient-controlled epidural analgesia: a preliminary study on a novel approach of providing pain relief in labour. Singapore Med J 47:951–956
Sng BL, Sia AT, Lim Y et al (2009) Comparison of computer-integrated patient-controlled epidural analgesia and patient-controlled epidural analgesia with a basal infusion for labour and delivery. Anaesth Intensive Care 37:46–53
Capogna G, Celleno D, Lyons G, Columb M, Fusco P (1998) Minimum local analgesic concentration of extradural bupivacaine increases with progression of labour. Br J Anaesth 80:11–13
Chua SM, Sia AT (2004) Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour. Can J Anaesth 51:581–585
Goodman SR, Smiley RM, Negron MA et al (2009) A randomized trial of break-through pain during combined spinal-epidural versus epidural labor analgesia in parous women. Anesth Analg 108:246–251
Boogmans T, Vertommen J, Valkenborgh T et al (2014) Epidural neostigmine and clonidine improves the quality of combined spinal epidural analgesia in labour: a randomised, double-blind controlled trial. Eur J Anaesthesiol 31:190–196
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Guasch, E., Gilsanz, F., de Ávila, A.S. (2015). Neuraxial Analgesia: Technical Problems and Solutions. In: Capogna, G. (eds) Epidural Labor Analgesia. Springer, Cham. https://doi.org/10.1007/978-3-319-13890-9_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-13890-9_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-13889-3
Online ISBN: 978-3-319-13890-9
eBook Packages: MedicineMedicine (R0)