[Epidural anesthesia for labor].

Cahiers d'anesthesiologie Pub Date : 1996-01-01
P Dailland, P Chaussis, J Landru, H Belkacem
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Abstract

Since the last decade, lumbar epidural analgesia has gained widespread use in obstetrics. Approximately 80% of parturients receive epidural analgesia for labour and vaginal delivery as well as caesarean section in most centres. There is little doubt that the most successful application of epidural analgesia during labour, considered by more than 75% of primiparas as extremely painful. The quality of analgesia is far superior to that which can be achieved by either parenteral or inhalation approaches and, unlike these methods, the mother remains alert. Epidural analgesia also prevents, or greatly diminishes, most of the physiological and chemical responses to labour pain that can be considered as stress responses, similar to those that have been described during surgery. There are considerable benefits, therefore, to both mother and child. Thus, epidural analgesia usually can be extended to relieve both uterine pain and pain related to distension of the lower birth canal, as well as providing analgesia for forceps delivery or caesarean section. Epidural analgesia allows the mother to be awake, minimizes or completely avoids the problems of maternal aspiration and avoids neonatal drug depression from general anaesthetics. If the most popular indication for epidural analgesia is the provision of pain relief, there are certain complications of pregnancy in which epidural analgesia appears to be indicated on therapeutic grounds such as pregnancy-induced hypertension, breech delivery, multiple pregnancy, incoordinate uterine action and fetal and/or maternal medical complications.

[分娩时硬膜外麻醉]。
近十年来,腰硬膜外镇痛在产科得到了广泛的应用。在大多数中心,大约80%的产妇在分娩和阴道分娩时接受硬膜外镇痛以及剖腹产。毫无疑问,分娩过程中最成功的应用硬膜外镇痛,被75%以上的初产妇认为是极度痛苦的。镇痛的质量远远优于肠外或吸入方法,与这些方法不同,母亲保持警觉。硬膜外镇痛还可以防止或大大减少分娩疼痛的大多数生理和化学反应,这些反应可以被认为是应激反应,类似于手术中描述的那些反应。因此,对母亲和孩子都有相当大的好处。因此,硬膜外镇痛通常可以扩展到缓解子宫疼痛和与下产道扩张相关的疼痛,以及为产钳分娩或剖宫产提供镇痛。硬膜外镇痛可使产妇保持清醒,最大限度地减少或完全避免产妇误吸的问题,并避免全身麻醉引起的新生儿药物抑郁。如果硬膜外镇痛最普遍的适应症是缓解疼痛,那么在某些妊娠并发症中,硬膜外镇痛似乎是出于治疗目的而需要的,如妊娠性高血压、臀位分娩、多胎妊娠、子宫活动不协调以及胎儿和/或母亲的医学并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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