Continuous Caudal Analgesia in Obstetrics*

Galley, A. H.

doi:10.1111/j.1365-2044.1949.tb05836.x

Cited by 7 publications

(2 citation statements)

References 4 publications

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“…From time to time small series have been reported by British workers who have used caudal or lumbar epidural analgesia in incoordinate uterine action (Galley, 1949;Johnson, 1952Johnson, , 1954Johnson, , 1957Arthur and Johnson, 1952 ;Ball and Chambers, 1956 ;Tunstall, 1960) and in pre-eclampsia and eclampsia (Bryce-Smith and Williams, 1955;Scott, 1955).…”

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Management of Incoordinate Uterine Action under Continuous Epidural Analgesia

Moir¹,

Willocks²

1967

BMJ

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In contrast, epidural techniques are extensively used for obstetric analgesia in many North American centres (Bush, 1959;Hingson et al., 1961; Hellmann, 1965;Moore, 1966) following on the pioneer work of Hingson and Edwards (1943). The reasons for this difference in practice are several.Firstly, British obstetric opinion is generally in favour of encouraging spontaneous delivery where this can safely be achieved, and most spontaneous deliveries are conducted by midwives in hospital and at home. Epidural analgesia, because it produces perineal anaesthesia and so abolishes the reflex expulsive efforts of the second stage of labour, is usually associated with a high forceps delivery rate.Secondly, epidural analgesia may be required at any time of the day or night, and its safe conduct necessitates the presence of an anaesthetist experienced in the technique for as long as the block is maintained. This demands a 24-hour obstetric anaesthetic service by experienced anaesthetists who are not itted to other duties. This service exists in few hospitals in Great Britain today, though in our experience the benefits are substantial and not confined to the administration of epidural analgesia.Finally was incoordinate uterine action. The present review was undertaken to assess the contribution made by epidural analgesia to the management of these cases. Anaesthetic TechniqueThe lumbar rather than the caudal approach to the epidural space is preferred because of the higher success rate, the lower dose of local anaesthetic drug, and because the skin of the lumbar region seems less open to contamination than the skin over the sacral hiatus. The caudal approach is used when abnormalities of the lumbar spine are present.Lumbar epidural puncture is performed with the patient in the sitting position to encourage spinal fleion, which may be difficult to achieve in the lateral position because of the gravid uterus. A 16 S.W.G. Tuohy needle is used and the epidural space is identified by the loss-of-resistance technique. A plastic catheter (Lee, 1962) with a blunt tip (Moir and Hesson, 1965) is then advanced into the epidural space, the needle is withdrawn, and the catheter is connected to a sterile plastic 50-ml. syringe filled with local anaesthetic solution. This syringe is now sealed inside a transparent bag (Cole, 1964) and strapped to the abdominal wall. This system allows top-up injections to be given without scrubbing-up and seems to avoid the risk of accidental overdosage associated with at least one of the drip techniques (Edmonds-Seal, 1964

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Management of Incoordinate Uterine Action under Continuous Epidural Analgesia

Moir¹,

Willocks²

1967

BMJ

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“…It is unlikely that continuous caudal analgesia will be used extensively in this country in the immediate future for the relief of pain in normal labour and delivery, because of the lack of trained personnel to induce, supervise, and maintain analgesia, though Galley (1949) has published a series of such cases. Nevertheless, it is clear that the continuous method can play an extremely useful part in the treatment of angiospastic states, and, in the words of a recent B.M.J.…”

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confidence: 99%