Current practice of epidural analgesia during normal labour. A survey of maternity units in the United Kingdom.
A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivacaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top-up, whereas 0.25% was most often used during the first stage of labour. Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
Davies
M W
MW
Department of Anaesthesia, Liverpool Maternity Hospital, Merseyside.
Harrison
J C
JC
Ryan
T D
TD
D015360:Analgesia, Epidural / Q000379:methods / Q000706:statistics & numerical data; D016362:Analgesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D005260:Female; D006757:Hospital Units; D006801:Humans; D007263:Infusions, Parenteral; D007743:Labor, Obstetric; D011247:Pregnancy; D006113:United Kingdom
D000779:Anesthetics, Local