Epidural anesthesia for vaginal delivery | Use of local anesthetics during pregnancy

Epidural anesthesia for vaginal delivery

In vaginal delivery there is the peculiarity that the local anaesthetics are administered in small doses only, so that only the nerve fibres for pain and temperature are blocked, but the patient can still actively use her muscles to support the birth by means of an abdominal press. The local anesthetic is always administered during the breaks in labor. This is important because the pressure of the contractions can cause the local anesthetic to rise uncontrollably upwards through the spinal canal!

Sometimes additives of sufentanil are also used. This results in better pain relief. The maximum dose here is 30 μg.

To reduce the pain during the opening contractions, one normally blocks the pain transmission from the 10 thoracic vertebrae to the 1 lumbar vertebra. Approximately 6-8 ml of 0.25% bupivacaine or 0.2% ropivacaine are required for this purpose. To reduce the pain in expulsion contractions, the pain transmission from the 10th thoracic vertebra to the 4th sacral vertebra is blocked.

Approximately 12 ml 0.25% bupivacaine or 0.2% ropivacaine is used. The pain therapy with the local anesthetics bupivacaine and ropivacaine lasts for about 2 hours. If necessary, more must be administered after 2 hours.