Τόμος 16 (2002) – Τεύχος 3 – Άρθρο 3 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Διεθνής Έκδοση – Volume 16 (2002) – Issue 3 – Article 3 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-International Edition

Title Epidural analgesia during normal labor
Authors Katerina Lykeridou¹ and Anna Deltsidou²

1. Technological Educational Institution of Athens (TEI), Athens, Greece

2. Technological Educational Institution of Lamia (TEI), Lamia, Greece

Citation Lykeridou, K., Deltsidou, A.: Epidural analgesia during normal labor, Epitheorese Klin. Farmakol. Farmakokinet. 16(3): 183-198 (2002)
Publication Date Received for publication: 2 October 2002

Accepted for publication: 20 November 2002

Full Text Language English
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Keywords Local anaesthetics, epidural analgesia during normal labor, pain relief in parturition.
Other Terms review article
Summary The subject of this literature review is the epidural analgesia/ anaesthesia for labor and vaginal delivery. Epidural analgesia is the most effective form of intrapartum analgesia currently available. The most commonly drugs are local anesthetics. Bupivacaine is the local anesthetic most often used for epidural analgesia during labor but in most cases that require rapid extension of anaesthesia is reserved chloroprocaine. Other drugs are lignocaine and ropivacaine. Because of avoidance the side effects associated with them, we combine them with opioids. The most common opiate agonist is fentatyl or sufentanil or alfentanil. In most cases, maternal request for pain relief represents a sufficient indication for administration of epidural analgesia, in hypertensive, also, disorders of pregnancy, in cardio-vascular, respiratory and neurological disease, in diabetes mellitus and in obese. The fetal indications are prematurity and intrauterine growth retardation, breech presentation, multiple pregnancy and intrauterine death. There are a lot of contraindications such us the maternal refusal, coagulation disorders, local or systemic sepsis, hypovolaemia, lack of trained staff and allergies. The most common complication of epidural analgesia is hypotension, but there are also sensory, motor and autonomic block, proprioception, maternal temperature, stress response, bladder function and dural puncture which may lead to headache after delivery.
References 1.    Bonica J.J.: The nature of pain in parturition. Clin. Obstet. Gynaecol. 2: 499 (1975).

2.    Moore J.: The effects of analgesia and anaesthesia on the maternal stress response. In Reynolds F, ed. Effects on the baby of maternal analgesia and anaesthesia. Pp. 148- 62, W.B. Saunders, London, 1993.

3.    Lederman R.P., Lederman E., Work B.A., McCann D.S.: The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am. J. Obstet. Gynecol. 132: 495-500 (1978)

4.    Ledeman RP, Lederman E, Work BA, McCann DS. Anxiety and epinephrine in multiparous woman in labor: relationship to duration of labor and fetal heart rate pattern. Am. J. Obstet. Gynecol. 153: 870-7 (1985).

5.    Bonica J.J.: Labour pain In: Textbook of pain. (Wall P.D., Melzack R., eds). Pp. 377- 92, Churchill Livingstone, Edinburg, 1984.

6.    Chamberlain G., Wraight A., Sleer P.: Pain and its relief in childbirth. (Report of the 1990 NBT Survey). Churchill Livingstone, Edinburg, 1993.

7.    Howell C.J., Chalmers I.: A review of prospectively controlled comparisons of epidural with non-epidural forms of pain relief during labour. Int. J. Obstet. Anesth. 1: 93- 110 (1992).

8.    Philipsen T., Jensen N.H.: Maternal opinion about analgesia in labour and delivery: a comparison of epidural blockade and intramuscular pethidine. Eur. J. Obstet. Gynecol. Reprod. Biol. 34: 205-10 (1990).

9.    Bergeret S., Loffredo P., Bosson J.L., Pafot M., Seebacher J., Benhamou D., Payen J.F.: Prospective national survey on alternatives to obstetrical peridural analgesia. Ann. Fr. Anesth. Reanim. 19(7): 530-9 (2000).

10.  Lurie S., Feinstein M., Heifetz C., Mamet Y.: Epidural analgesia for labor pain is not associated with a decreased frequency of uterine activity. Int. J. Gynaecol. Obstet. 65(2): 125-7 (1999)

11.  Philipsen T., Jensen N.H.: Epidural block or parenteral pethidine as analgesic in labour: a randomized study concerning progress in labour and instrumental deliveries. Eur. J. Obstet. Reprod. Biol. 30: 27-33 (1989).

12.  Peach M.J.: The King Edward Memorial Hospital 1000 mother survey of methods of pain relief in labour. Anaesth. Intensive Care 19: 393-9(1991).

13.  Aps C., Reynolds F.: The effect of concentration on vasoactivity of bupivacaine and lignocaine. Br. J. Anaesth. 48: 1171-4(1976).

14.  Willatts D., Reynolds F.: Comparison of the vasoactivity of amide and ester local anaesthetics: an intradermal study. Br. J. Anaesth. 57: 1006 (1985).

15.  Aps C., Reynolds F.: An intradermal study of the local anaesthetic and vascular effects of the isomers of bupivacaine. Br. J. Cli.. Pharmacol. 6: 63-8 (1978).

16.  Reynolds F.P Taylor G.: Maternal and neonatal blood concentrations of bupivacaine. A comparison with lignocaine during continuous extradural analgesia. Anaesthesia 25: 14-23(1970).

17.  Reynolds F., Hargrove R.L., Wyman J.B.: Maternal and foetal plasma concentrations of bupivacaine after epidural block. Br. J. Anaesth. 45: 1049-53 (1973).

18.  Zhang J., Ktebanoff M.A., DerSimonian R.: Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Comment in: Am. J. Obstet. Gynecol. 183(1): 258 (2000).

19.  Belfrage P., Berlin A., Raabe N., et al.: Lumbar epidural analgesia with bupivacaine in labor. Am. J. Obstet. Gynecol. 123: 839-44 (1975).

20.  Irestedt L., Ekblom A., Olofsson C., Dahlstrom A.C., Emanuelsson B.M.: Pharmacokinetics and clinical effect during continuous epidural infusion with ropivacaine 25 mg/ml or bupivacaine 2.5 mg/ml for labour pain relief. Acta Anaesthesiol. Scand. 42(8): 890-6 (1998).

21.  Grice S.C., Eisenach J.C., Dewan D.M.: Labor analgesia with epidural bupivacaine plus fentanyl: enhancement with epinephrine and inhibition with chloroprocaine. Anesthesiology 72: 623-8 (1990).

22.  Kuhnert P.M., Philipson E.H., et al.: The half-life of 2-chloroprocaine. Anesth. Analg. 65: 273-8 (1986).

23.  Zaric D., Nydahl P.A., Philipson L., Samuelsson L., Heierson A., Axefsson K.: The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) and 0.25% bupivacaine on sensory and motor bock in volunteers. Reg. Anesth. 2: 14-25 (1996).

24.  Zackova M., Manfredini P., Strali W., Baravelli A., Furnari G., Accorsi A.: Comparison of 0.125% bupivacaine and 0.2% ropivacaine in obstetric analgesia. Minerva Anesthesiol. 66(9): 643-8 (2000).

25.  McClellan K.J., Faulds D.: Ropivacaine: an update of its use in regional anaesthesia. Drugs 60(5): 1065-93 (2000).

26.  Finegold H., Mandell G., Ramanathan S.: Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125%- fentanyl infusion for epidural labour analgesia. Can. J. Anaesth. 47(8): 740-5 (2000).

27.  Ruban P., Sia A.T., Chong J.L.: The effect of adding fentanyl to ropivacaine 0.125% on patent-controlled epidural analgesia during labour. Anaesth. Intensive Care 28(5): 517-21 (2000).

28.8ernards C., Hill H.F.: Morphine and alfentanil permeability through the spinal dura, arachnoid and pia mater of dogs and monkeys. Anesthesiology 73: 1214-19 (1990).

29.  Gerdine A., Salmonston T., Lindberg B., Rane A.: Maternal kinetics of morphine during labor. J. Perinat. Med. 18: 479-87(1990).

30.  Olsen G.D.: Morphine binding to plasma proteins. Clin. Pharmacol. Ther. 17: 31-5 (1975).

31.  Gerdine E., Rane A., Lindberg B.: Transplacental transfer of morphine in man. J. Perinat. Med. 18: 305-11 (1990).

32.  Abboud T.K., Shnider S.M., Dailey P.A. et al.: Intrathecal administration of hyperbaric morphine for the relief of pain in labor. Br. J. Anaesth. 56: 1351-60 (1984).

33.  Russell R., Reynolds F.: Epidural infusions for nulliparous women in labour. A randomised double blind comparison of fentanyl/bupivacaine and sufentanil/bupivacaine. Anaesthesia 48: 856-61 (1993).

34.  Craft J.B., Coaldrake LiA., Bolan J.C., et al.: Placental passage and uterine effects of fentanyl. Anesth. Analg. 62: 894-8 (1983).

35.  Chen L.K., Hsu H.W., Lin C.J., Huang D.H., Tsai S.K., Lee C.N., Hsieh F.J.: Effects of epidural fentanyl on labor pain during the early period of the first stage of induced labor in nulliparous women. J. Formos. Med. Assoc. 99(7): 549-53 (2000).

36.  Collis R.E., Darvies D.W.L., Aveling W.: Randomised comparison of combined spinal epidural and standard epidural analgesia in labour. Lancet 345: 1413-16 (1995).

37. Cheng C.J., Sia A.T., Um E.H., Loke G.P., Tan H.M.: Either sufentanil or fentanyl, in addition to intrathecal bupivacaine, provide satisfactory early labour analgesia. Can. J. Anaesth. 48(6): 570-4 (2001).

38.  Smedvig J.P., Soreide E., Gjesslng L.: Ropivacaine 1mg/ml, plus fentanyl 2μg/ml for epidural analgesia during labour. Is mode of administration important? Acta Anaesthesiol. Scand. 45(5): 595-9 (2001).

39.  Russell R., Reynolds F.: Epidural intusions for nulliparous women in labour. A randomised double blind comparison of fentanyl/bupivacaine and sfentanil/bupivacaine. Anaesthesia 48: 856-61 (1993).

40.  Hays R.L., Palmer C.M.: Respiratory depression after intrathecal sufentanil during labor. Anesthesiology 81: 511- 12 (1994).

41.  Camann W., Denney R., Holby E., Datta S.: A comparison of intrathecal, epidural and intravenous sufentanil for labor analgesia. Anesthesiology 77: 884-7 (1992).

42.  Eriksson S.L., Frykholm P., Stenlund P.M., Otofsson C.: A comparison of three doses of sufentail in combination with bupivacaine-adrenaline in continuous epidural analgesia during labour. Acta Anaesthesiol. Scand. 44(8): 919-23 (2000).

43.  Bader A.M., Ray N., Datta S.: Continuous epidural infusion of alfentanil and bupivacaine for labor and delivery. Int. J. Obstet. Anesth. 1: 187-90 (1992).

44.  Husemeyer R.P., Cummings A.J., Rosenkiewicz J.R., Davenport H.T.: A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration. Br. J. Clin. Pharmacol. 13: 171- 6 (1982).

45.  Hughes D.A., Hill D.A.: Intrathecal alfentanil with and without bupivacaine for analgesia in labour. Anaesthesia 55(11): 1116-21 (2000).

46.  Camann W.R., Bader A.M.: Spinal anesthesia for cesarean delivery with meperidine as the sole agent. Int. J. Obstet. Anesth. 1: 156-8 (1992).

47.  Girvan C.B., Moore J., Dundee J.W., Pethidine compared with pethidine-naloxone administered during labor. Br. J. Anaesth. 48: 563-9 {1976).

48.  Gerhardt T., Bancalari E., Cohen H., Rocha L.F.: Use of naloxone to reverse narcotic respiratory depression in the newborn infant. J. Pediatr. 90: 1009-12 (1977).

49.  American Academy of Pediatrics Committee on Drugs. Emergency drug doses for infants and children and naloxone use in newborns: clarification. Pediatrics 83: 803 (1989).

50.  American Heart Association Emergency Cardiac Care Committee and Subcommittees. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part VII. Neonatal resuscitation. JAMA 268: 2276-81 (1992).

51.  Eisenach J., Detweiler D., Hood D.: Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 78: 277-87 (1993).

52.  Yarnell R.W., Ewing D.A., Tierney E.: Sacralization of epidural block with repeated doses of 0.25% bupivacaine during labor. Reg. Anesth. 15: 275-9 (1990).

53.   0‘Meara M.E., Gin T.: Comparison of 0.125% bupivacaine with 0.125% bupivacaine and clonidine as extradural analgesia in the first stage of labour. Br. J. Anaesth. 71: 651-6 (1993).

54.  Eisenach J.C., D’Angelo R., Taylor C., Hood D.D.: An isobolographic study of epidural clonidine and fentanyl after cesarean section. Anesth. Analg. 79: 285-90 (1994).

55.  Brichant J.F., Bonhomme V., Mikulskl M., Lamy M., Hans P.: Admixture of clonidine to extradural bupivacaine for analgesia during labor: effect of varying clonidine doses. Anesthesiology 81: A1136 (1994).

56.  Kizilarslan S., Kuvaki B., Onat U., Sagiroglu E.: Epidural fentanyl-bupivacaine compared with clonidine- bupivacaine for analgesia in labour. Eur. J. Anaesthesiol. 17(11): 692-7 (2000).

57.  Celleno D., Capogna G., Contantino P., Zangrillo A.: Comparison of fentanyl with clonidine as adjuvants for epidural analgesia with 0.125% bupivacaine in the first stage of labor. Int. J. Obstet. Anesth. 4: 26-9 (1995).

58.  Chassard D., Mathon L., Dailler F., Golfier F., Tournade J.P., Bouletreau P.: Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour. Br. J. Anaesth. 77: 458-62 (1996).

59.  Claes B., Soetens M., Van Zundert A., Datta S.: Clonidine added to bupivacaine-epinephrine-sufentanil improves epidural analgesia during childbirth. Reg. Anesth. Pain Med. 23(6): 540-7 (1998).

60.  Hood D.D., Eisenach J.C., Mallak K., Tuttle R.: Interaction between intrathecal neostigmine and epidural clonidine in humans. (Abstract) Society for Obstetric Anesthesia and Perinatology, meeting: 44 (1995).

61.  Nelson K.E., D’Angelo R., Foss M.L., Meister G.C., Hood D.D., Eisenach J.C.: Intrathecal neostigmine and sufentanil for early labor analgesia. Anesthesiology 91 (5): 1293-8 (1999).

62.  Jouppila R., Jouppila P., Hollmen A., Koivula A.: Epidural analgesia and placental blood flow during labour in pregnancies complicated by hypertension. Br. J. Obstet. Gynaecol. 86: 969-72 (1979).

63.  Ramanathan J., Coleman P., Sibai B.: Anesthetic modification of hemodynamic and neuroendocrine stress responsiveness to cesarean delivery in women with severe preeclampsia. Anesth. Analg. 73: 772-9 (1991).

64.  Mangano D.T.: Anesthesia for the pregnant cardiac patient. In: Anesthesia for obstetrics (Shnider S.M., Levinson G., eds). Pp. 485-523, Williams & Wilkins, Baltimore, 1993.

65.  Robson S.C.: The danger of convulsions precludes the use of regional analgesia for caesarean section in fulminating preeclampsia-Opposer. Int. J. Obstet. Anesth. 2: 104-5 (1993).

66.  Department of Health and others: Report on Confidential Enquiries into Maternal Deaths in the UK, 1988-1990, London: HMSO, 1994.

67.  Hollmen A., Jouppila R., Jouppila P., Koivula A., Vierola H.: Effect of extradural analgesia using bupivacaine and 2-chloroprocaine on intervillous blood flow during normal labour. Br. J. Anaesth. 54: 837-42 (1982).

68.  Osbourne G.K., Patel N.B., Howat R.C.L.: A comparison of outcome of low birthweight pregnancy in Glasgow and Dundee. Health Bull. 42: 68-77 (1984).

69.  Van Zundert A., Vaes L., Soetens M., et al.: Are breech deliveries an indication for lumbar epidural analgesia? Anesth. Analg. 72: 399-403(1991).

70.  Crawford J.S.: A prospective study of 200 consecutive twin deliveries. Anaesthesia 42: 33-43 (1987).

71.  Bogod D.: What to tell the patient: Consent and communication. (Abstract) Obstetric Anaesthetics Association Meeting: 53-4 (1995).

72.  Borum S.E., McLeskey C.H., Williamson J.B., Harris E.S., Knight A.B.: Epidural abscess after obstetric epidural analgesia. Anesthesiology 82: 1523-6 (1995).

73. Obstetric Anaesthetists Association. Recommended minimum standards for obstetric anaesthesia services. Int. J. Obstet. Anesth. 4: 125-8 (1995).

74.  Noble D.S., Pierce G.F.M.: Allergy to lignocaine. A case history. Lancet ii: 1436 (1961).

75.  Yeoman C.M.: Hypersensivity to prilocaine. Br. Dent. J. 153: 69-70 (1982).

76.  Brown D.T., Beamish D., Wildsmith J.A.W.: Allergic reaction to an amide local anaesthetic. Br. J. Anaesth. 53: 435-7 (1981).

77.  Hollmen A., Jouppila R., Pihlajaniemi R., et al.: Selective lumbar epidural block in labour: a clinical analysis. Acta Anaesth. Scand. 21: 174-81 (1977).

78.  Tong C., Eisenach J.C.: The vascular mechanism of ephedrine’s beneficial effect on uterine perfusion during pregnancy. Anesthesiology 76: 792-8 (1992).

79.  Murphy J.D., Henderson K., Bowden M.I., Lewis M., Cooper G.M.: Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction. Br. Med. J. 301: 564-7 (1991).

80.  Russell R., Reynolds F.: Epidural infusion of low-dose bupivacaine and opioid in labour. Does reducing motor block increase the spontaneous delivery rate? Anaesthesia 51: 266-73 (1996).

81.  Collis R.E., Davies D.W.L., Aveling W.: Randomised comparison of combined spinal-epidural with standard epidural analgesia in labour. Lancet 345: 1413-16 (1995).

82.  Mac Arthur C., Lewis M., Knox E.G.: Investigation of long term problems after obstetric epidural anaesthesia. Br. Med. J. 304: 1279- 82 (1992).

83.  Buggy D., Hughes N., Gardiner J.: Posterior column sensory impairment during ambulatory extradural analgesia in labour. Br. J. Anaesth. 73: 540-2 (1994).

84.  Parry M.G., Bawa G.P.S., Poulton B., Fernando R.: Dorsal column function in parturients receiving epidural and combined spinal epidural for labour and elective caesarean section. Int. J. Obstet. Anesth. 5: 213 (1996).

85.  Camann W.R., Horvet L.A., Hughes N., Bader A.M., Datta S.: Maternal temperature regulation during extradural analgesia for labour. Br. J. Anaesth. 67: 565-8 (1991).

86.  Fusi L., Maresh M.J.A., Steer P.J., Beard R.W.: Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet i: 1250-2 (1989).

87.  Westgren M., Lindahl S.G.E., Norden N.E.: Maternal and fetal endocrine stress response at vaginal delivery with and without epidural block. J. Perinat. Med. 14: 235-41 (1986).

88.  Shnider S.M., Abboud T.K., Artal R.: Maternal catecholamines decrease during labour after epidural anaesthesia. Am. J. Obstet. Gynecol. 147: 13-15 (1983).

89.  Hollmen A.I., Jouppila R., Jouppila P., Koivula A., Vierola H.: Effects of extradural analgesia using bupivacaine or 2-chloroprocaine on intervillous blood flow during normal labour. Br. J. Anaesth. 54: 837-42 (1982).

90.  Dray A.: Epidural opiates and urinary retention: new models provide new insights (Editorial) Anesthesiology 68: 323-4 (1988).

91.  Chadwick H.S.: An analysis of obstetric anesthesia cases from the American Society of Anesthesiologists closed claims project database. Int. J. Obstet. Anesth. 5: 258-63 (1996).

92.  Glosten B.: Obstetric anesthesia risk a review of recent literature. Int. J. Obstet. Anesth. 3: 7-12 (1994).

93.  Halpern S., Preston R.: Postdural puncture headache and spinal needle design: meta-analysis. Anesthesiology 81: 1376-83 (1994).

94.  Stride P.C., Cooper G.M.: Dural taps revisited. Anaesthesia 48: 247-55(1993).

95.  Thorburn J., Moi D.D.: Bupivacaine toxicity in association with extradural anaesthesia for caesarean section. Br. J. Anaesth. 56: 551-2 (1984).

96.  Ong B.Y., Cohen M.M., Esmail A., Cumming M, Kozody R., Palahnluk R.J.: Paresthesias and motor dysfunction after labor and delivery. Anesth. Analg. 66: 18-22 (1987).

97.  Holdcroft A., Gibberd F.B., Hargrove R.L., Dawkins D. F., Dellaports C.I.: Neurological complications associated with pregnancy. Br. J. Anaesth. 75: 522-6 (1995).

98.  Russell R., Dundas R., Reynolds F.: Long-term backache after childbirth: prospective search for causative factors. Br. Med. J. 312: 1384-8 (1996).

99.  Nimmo W.S., Wilson J., Prescott LF.: Narcotic analgesia and delayed gastric emptying during labour .Lancet i: 890-3 (1975).

100. Wright P.M.C., Allen R.W., Moore J., Donelly J.P.: Gastric emptying during lumbar extradural analgesia in labour: effect of fentanyl supplementation. Br. J. Anaesth. 68: 248-51 (1992).

101. Porter J., Bonello E., Reynolds F.: The influence of epidural fentanyl infusion on gastric emptying in labour. Int. J, Obstet. Anesth. 4: 261 (1995).

102. Naulty J.S., March M.G., Leavitt K.L., Smith R., Urso P.R.: Effects of changes in labor analgesia on practice outcome. Anesthesiology 77: A979 (1992).

103. Chestnut D.H., Vincent R.D., Choi W.W. et al.: Does early administration of epidural anesthesia prolong labor or Increase the incidence of cesarean section for dystocia. Society for Obstetric Anesthesia and Perinatology (1991).

104. Flamm B.L., Newman L.A., Thomas S.J., et al.: Vaginal birth after cesarean section: results of a 5-years multicenter collaborative study. Obstet. Gynecol. 76: 750-4 (1990).

105. Leong E.W., Sivanesaratnam V., Oh L.L., Chan Y.K.: Epidural analgesia in primigravidae in spontaneous labour at term: a prospective study. J. Obstet. Gynaecol. Res. 26(4): 271-5 (2000).

106. Kilpatrick S.J., Laros R.K.: Characteristics of normal labor. Obstet. Gynecol. 74: 85-87 (1989).

107. Thorp J.A., Hu D.H., Albin R.M., et al.: The effect of intrapartum epidural analgegia on nulliparous labor: a randomized, controlled, prospective study. Am. J. Obstet. Gynecol. 169: 851-8 (1993).

108. Ramin S.M., Gambling D.R., Lucas M.J., Sharma S.K., Sidawi J.E., Leveno K.J.: Randomized trial of epidural versus intravenous analgesia during labor. Obstet. Gynecol. 86: 783-9 (1995).

109. Reynolds F., Taylor G.: Maternal and neonatal concentrations of bupivacaine: a comparison with lignocaine during continuous extradural analgesia. Anaesthesia 25: 14-23 (1970).

110. Jani K., McEvedy B., Harris S., Samaan A.: Maternal and neonatal bupivacaine concentrations after spinal and extradural anaesthesia for caesarean section. Br. J. Anaesth. 62: 226-7(1989).

111. Russel R., Reynolds F.: Epidural infusion of low-dose bupivacaine and opioid in labour. Does reducing motor block increase the spontaneous delivery rate? Anaesthesia 51: 266-73(1996).

112. Porter J., Reynolds F.: The effect of epidural opioids on neonatal respiration. Int. J. Obstet. Anesth. 5: 210 (1996).

113. Heytens L., Cammu H., Cammu F.: Extradural analgesia during labour using alfentanil. Br. J. Anaesth. 59: 331-7 (1987).

114.        Capogna G., Celleno D., Tomasetti M.: Maternal analgesia and neonatal neurobehavioral effects of epidural sufentanil for cesarean section. Abstracts of the Congress of Regional Anesthesia 14: 24 (1989).

115. Hollmen A.I., Jouppila R., Jouppila P., Koivula A., Vierola H.: Effects of extradural analgesia using bupivacaine or 2-chloroprocaine on intervillous blood flow during normal labour. Br. J. Anaesth. 54: 837-42 (1982).

116. Groves P.A., Oriol N.E.: How useful is intrapartum electronic fetal heart rate monitoring. Int. J. Obstet. Anesth. 4: 161-7 (1995).

117. Obstetric Anaesthetists’ Association Working Party. Recommended minimum standards for obstetric anaesthesia services. Int. J. Obstet. Anesth. 4: 125-8 (1995).

118. Rickford W.J.K., Reynolds F.: Epidural analgesia in labour and maternal posture Anaesthesia 38: 1169-74 (1983).

119. Abboud T.K., Afrasiabi A., Sarkis F., et al.: Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine or lidocaine- maternal, fetal and neonatal effects. Anesth. Analg. 63: 421-8 (1984).

120. Milaszkiewicz R., Payne N., Loughnan B„ Blackett A., Barber N., Carli F.: Continuous extradural infusion of lignocaine 0.75% vs bupivacaine 0.125% in primtparae: quality of analgesia and influence on labour. Anaesthesia 47: 1042-6 (1992).

121. McCrae A.F., Jowiak H., McClure J.H.: Comparison of ropivacaine and bupivacaine in extradural analgesia for the relief of pain in labour. Br. J. Anaesth. 74: 261-5 (1995).

122. Reynolds F.: Effects on the baby of conduction blockade in obstetrics. In: Epidural and spinal blockade in obstetrics (Reynolds F. ed). Pp. 205-218, Bailleres Tindall, London, 1990.

123. Hollmen A.I., Jouppila R., Albright G.A.: Intervillous blood flow during caesarean section with prophylactic ephedrine and epidural analgesia. Acta Anaesth. Scand. 28: 396-400 (1984).

124. Rasanen J., Alahuhta S., Kangas-Saarela T., Jouppila R., Jouppla P.: The effects of ephedrine and epinephrine on uterine and fetal blood flow and on fetal myocardial function during spinal anaesthesia for caesarean section. Int. J. Obstet. Anesth. 1: 3-8 (1991).

125. Alahuhta S., Rasanen J., Jouppila P., Jouppila R., Hollmen A.I.: Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Int. J. Obstetr. Anesth. 1129-34 (1992).

126. Pearson J.F., Davies P.: The effect of continuous lumbar epidural analgesia upon fetal acid-base status during the first stage of labor. J. Obstet. Gynaecol. Br. Commonwelth 81: 971-4(1974).

127. Thalme B., Belfrage P., Raabe N.: Lumbar epidural analgesia in labour: I. Acid-base balance and clinical condition of the mother, fetus and newborn child. Acta Obstet. Gynecol. Scand. 53: 27-35 (1974).

128. Deckardt R., Fernacher P.M., Schneider K.T.M., Graeff H.: Maternal arterial oxygen saturation during labor and delivery: pain dependent alterations and effects on the newborn. Obstet. Gynecol. 70: 21-5 (1987).

129. Thorp J.A., Hu D.H., Albin R.M., et al.: The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective study. Am. J. Obstet. Gynecol. 169: 851-8 (1993).

130. Ramin S.M., Gamblng D.R., Lucas M.J., Sharma S.K., Sidawi J.E., Leveno K.J.: Randomized trial of epidural versus intravenous analgesia during labor. Obstet. Gynecol. 86: 783-9 (1995).

131. Ong B.Y., Cohen M.M., Palahniuk J.: Anesthesia for caesarean section-effects on neonates. Anesth. Analg. 68: 270-5 (1989).

132. Evans C.M., Muphy J.F., Gray O.P., Rosen M.: Epidural versus general anaesthesia for elective caesarean section. Effect on Apgar score and acid-base status of the newborn. Anaesthesia 44: 778-82 (1989).

133. Brazelton T.B.: Neonatal Behavioral Assessment Scale. In: Clinics in Developmental Medicine, 2nd ed, No. 88.       Pp. 125 Blackwell, London, 1984.

134. Scanlon J.W., Brown W.U., Weiss J.B., Alper M.H.: Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 40: 121-8 (1974).

135. Amiel Tison C., Barrier G., Shnider S.M., Levinson G., Hughes S.C., Stefani S.J.: A new neurologic and adaptive capacity scoring system for evaluating obstetric medication In full term newborns. Anesthesiology 56: 340-50 (1982).

136. Porter J., Reynolds F.: The effect of epidural opioids on neonatal respiration. Int. J. Obstet .Anesth. 5: 210 (1996).

137. Mayberry L.J. & Gennaro S. A.: Quality of Health Outcomes Model for guiding obstetrical practice. J. Nurs. Schoiarsh. 33(2): 141-6 (2001)

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