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New trends in obstetric pain relief

I. CONTINUOUS EPIDURAL INFUSION OF LOCAL ANESTHETICS Compared with intermittent epidural bolus injections, continuous infusions offer several advantages. These are: more consistent level of analgesia, need for fewer top-up doses (1-3), less hemodynamic instability (3), and lower risk of toxic reactions. The local anesthetic infusion should be as dilute as possible, yet still provide adequate analgesia. This is in order to minimize the degree of motor blockade and reduce the risk of systemic toxicity. With the use of bupivacaine optimal results were obtained with a 0.125% concentration infused at the rate of 10 ml/hour (4). While the use of a continuous epidural infusion will lessen the demands on the obstetric anesthesia service, it by no means obviates the need for patient monitoring. In addition to careful nursing observation, the anesthesiologistshould reevaluate the patient at least every two hours.