The effect of epidural analgesia in labour on maternal respiratory function.
Lumbar epidural analgesia during labour has gained widespread acceptance. The impact of epidural analgesia based on mixtures of low-dose local anaesthetic solutions and lipophilic opioids on most clinically relevant obstetric outcomes is minimal. Since the pregnant state per se is associated with important alterations in respiration, we assessed whether a subtle degree of motor blockade brought about by epidural analgesia might compromise respiratory function as assessed by spirometry. Sixty consenting parturients receiving epidural analgesia were consecutively included in this prospective study. We performed spirometry during the antepartum visit and in labour after effective epidural analgesia was established; at both assessments the women were pain-free. Values were within normal ranges but increased significantly after effective epidural analgesia; median (IQR [range]) increase for vital capacity 7.4 (3.0-13 [-12-27])% (p < 0.001); forced vital capacity 4.4 (1.7-9.8 [-13-26])% (p < 0.001); forced expiratory volume in 1 s 5.5 (1.7-8.6 [-14-28])% (p < 0.001); and peak expiratory flow rate 2.3 (-1.6-5.8 [-18-16])% (p = 0.01)). We conclude that epidural analgesia for labour significantly improved respiratory function.
von Ungern-Sternberg
B S
BS
Department of Anaesthesia, University of Basel/Kantonsspital, CH 4031 Basel, Switzerland. bvonungern@uhbs.ch
Regli
A
A
Bucher
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Reber
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Schneider
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MC
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000494:pharmacology*; D015992:Body Mass Index; D002045:Bupivacaine / Q000494:pharmacology; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena / Q000187:drug effects*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine