Epidural anesthesia by the two-catheter technic for vaginal delivery: its effects on fetal heart rate and uterine contractions, and maternal/fetal acid-base balance
Takaya, T.
Masui. Japanese Journal of Anesthesiology 37(1): 36-46
1988
ISSN/ISBN: 0021-4892 PMID: 3367499 Document Number: 326432
In our previous paper, we reported on a two-catheter epidural technique for vaginal delivery. In brief, with this technique, one catheter is inserted at the level of L4-5 and advanced caudad, while the other at L1-2 and directed cephalad. By varying the dosage and time of supplementation according to the patients' need, total dose of the local anesthetics can be reduced while satisfactory pain relief is assured. With the further studies reported here, we evaluated the effect of this anesthetic technique on fetus (FHR: interval index and differential index of Yeh) and uterine activity (peak pressure, duration, interval, tonus, area, dP/dtmax, slope, kurtosis, and skewness). We observed no change in most of these parameters for 30 .apprx. 40 minutes after the epidural block. In addition, in order to see if this anesthetic management reduces overall stress on the mother and fetus, we compared the epidural group with the non-anesthetised in respect to the duration of labor, and changes in blood gas values as well as blood levels of lactate and pyruvate in both maternal and umbilical arterial samples. The result revealed that the duration of active phase of labor in the epidural group was almost the same as in the non-anesthetised group, though the duration of 2nd stage was longer in the former group. Maternal L/P ratio, lactate level, and umbilical pyruvate, lactate level were lower in the epidural group. We conclude that epidural block by two-catheter technique alleviates the exhaustion of mother and baby without disturbing the natural course of labor.