Local and Regional Analgesia for Labor and Delivery

• Published in: Complications of Regional Anesthesia pp. 303 - 317
• Main Authors: Chan, Yoo Kuen, Tan, Peng Chiong
• Format: Book Chapter
• Language: English
• Published: Cham Springer International Publishing 2017
• Subjects: Cardiac arrest; Complications; Infection; Neurologic deficits; Obstetric anesthesia; Paracervical block; Pudendal block; Regional anesthesia; Total spinal
• ISBN: 3319493841; 9783319493848
• DOI: 10.1007/978-3-319-49386-2_18

Regional anesthesia is a safe, effective, and widely used modality for caesarean section delivery. In addition it is useful for controlling labor pain and postoperative pain. While severe complications are rare, common complications, such as hypotension, must be considered when using neuraxial anesthesia.Hypotension occurs in around half of individuals receiving central neuraxial block; coloading with crystalloid is a common method to prevent hypotension. Administration of vasopressors may be required to stabilize blood pressure.Local anesthetic toxicity is a potential complication, given the abundant vascularity of the epidural space; this presents concern for both parturient and fetus. Treating every epidural dose as a test dose can help avoid infusion of toxic doses.Paracervical and pudendal blocks are decreasing in popularity due to inadequate pain control and associated complications.Other complications to be considered in the obstetric population include neurologic dysfunction, infection, chronic adhesive arachnoiditis, postdural puncture headache, cauda equina lesion, damage to the spinal cord, transient neurologic symptoms, inadequate/extensive block, and rarely, respiratory and cardiac arrest.