RT Book, Section
A1 Sween, Lindsay K.
A2 Hess, Philip E.
A2 Li, Yunping
A2 Kowalczyk, John J.
A2 Stiles, Justin K.
SR Print(0)
ID 1199673979
T1 Low-Concentration Labor Epidural Analgesia
T2 Obstetric Anesthesia: Quick References & Practical Guides
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264671465
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1199673979
RD 2024/04/23
AB Of  the  pharmacologic  and  nonpharmacologic  options  for  labor  analgesia,  neuraxial  analgesia  is  the  gold  standard  with  the  highest  efficacy  in  terms  of  visual  analog  scale  pain  scores  and  patient  satisfaction.1  Historically,  high  concentration  local  anesthetic  solutions  (0.25-0.5%  bupivacaine)  were  used  to  induce  and  maintain  epidural  analgesia.  However,  these  epidural  solutions  resulted  in  significant  hypotension,  fetal  bradycardia,  maternal  lower  extremity  motor  blockade,  and  subsequent  impaired  second  stage  of  labor.1  More  recently,  dilute  local  anesthetic  solutions  (≤0.1%  bupivacaine  or  equipotent  ropivacaine)  have  gained  favor  due  to  decreased  maternal  motor  block,  increased  maternal  mobility,  shorter  second  stage  of  labor,  and  decreased  need  for  assisted  vaginal  delivery  compared  to  more  concentrated  solutions.1,2  Dilute  local  anesthetic  solutions  have  been  demonstrated  to  yield  the  same  length  of  labor  and  rate  of  assisted  vaginal  delivery  and  cesarean  delivery  as  nonepidural  analgesic  options.3  Maternal  satisfaction  with  labor  analgesia  has  been  shown  to  be  equivalent  with  lower  concentration  epidural  solutions  compared  to  more  concentrated  solutions.2,4