Walking epidurals for labour analgesia: do they benefit anyone?

摘要: The ‘‘walking epidural’’ first appeared in the early 1990s. In some ways, it tested our widely held beliefs about how to provide effective and safe labour epidural analgesia responded women’s requests have without being confined bed. versions of walking epidural, combined spinalepidural (CSE) technique was used. It provided initial with intrathecal narcotic, which followed by a more standard continuous infusion. This novel challenged assumptions amount neuraxial medication needed initiate maintain analgesia. Many studies ensued that resulted significant changes both dosing strategies, they led deeper understanding way local anesthetics opioids work alone synergistically neuraxium. Critical assessment ambulation an situ has enormous benefit women labour, changed anesthesiologists analgesia, added body literature convince skeptical colleagues obstetrics epidurals don’t necessarily mean operative delivery. end result this scientific activity is patient-controlled low-dose solutions—there are so many benefits simple phrase. So, why enthusiasm for faded? While true per se not been shown alter outcome, maintaining mobility appeals although may be at point requiring fact take full advantage opportunity does negate its other minimizing motor block. also ‘‘mobile mom’’ can create staff; however, once establish management safety protocols ambulation, belongs nurse and/or midwife, whom support mobility. Safety perambulating parturient established—her balance just as good any pregnant woman’s term, blood pressure possibly stable than woman who remains lying bed fetus probably from complete absence aortocaval compression. movement stalled? Have lost their taste CSE because fetal bradycardia maternal pruritus? CSEs opened door mobility, clearly proven no component incredibly well allow ambulation. Perhaps we should reflect on reason ‘‘fad’’ started. Standard (aka dense) did always lead satisfaction sense loss control increased need instrumental vaginal delivery, especially if mother primiparous. intrepid obstetrical began challenge status quo experiment techniques using lipid soluble narcotics progressively dilute solutions space subsequent then applying technology. used ability ambulate one required outcomes, R. Preston, MD (&) Department Anesthesia, BC Women’s Hospital Health Centre, Rm 1Q72, 4500 Oak Street, Vancouver, V6H 3N1, Canada e-mail: rpreston@cw.bc.ca