Effect of combined spinal-epidural ambulatory labor analgesia on balance.
BACKGROUND
Low-dose combined spinal-epidural analgesia in labor has proved popular with women because lower-limb motor power is preserved, allowing ambulation. However, there has been debate about the safety of allowing women to walk following low-dose regional analgesia because of somatosensory impairment. The authors undertook a prospective controlled observational study using computerized dynamic posturography to examine balance function in pregnant women after combined spinal-epidural analgesia.


METHODS
The authors performed posturographic testing on 44 women in labor after institution of regional analgesia and compared them with a control group of 44 pregnant women. A separate group of six women were tested both before and after combined spinal-epidural analgesia.


RESULTS
Neurologic examination after regional analgesia showed two parturients (4%) to have motor weakness (excluded from posturography). Four women (9%) had clinical dorsal column sensory loss; these women all completed posturography. The spinal-epidural analgesia group showed a small, statistically significant reduction in one of six posturographic sensory-organization tests; however, this difference was functionally minor. There were no other differences in posturography between the control and spinal-epidural groups. Similar results were found in the paired study, in which there was minimal change in balance function after spinal-epidural analgesia.


CONCLUSIONS
This is the first study to objectively examine the effect of spinal-epidural analgesia on balance function. Using computerized dynamic posturography, the authors were unable to find any functional impairment of balance function after spinal-epidural ambulatory analgesia in women in labor who had no clinical evidence of motor block.
Pickering
A E
AE
Department of Anesthesia, Royal Free Hospital, London, United Kingdom.
Parry
M G
MG
Ousta
B
B
Fernando
R
R
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D005260:Female; D006801:Humans; D004856:Postural Balance; D011187:Posture; D011247:Pregnancy; D011446:Prospective Studies