Abstract

The efficacy and safety of a continuous epidural infusion of bupivacaine was studied in 1000 parturients in active labor. The method of epidural analgesia called “mini-infusion” comprises the use of 0.25% bupivacaine, placement of the catheter tip at the T-12 level, maintenance of analgesia by volumetric pump infusion at a rate of 5 ml/h, and change of the mother's position from the lateral supine to the semirecumbent in accordance with the progress of delivery. Satisfactory and constant analgesia was achieved in 90.5% of the patients in the first stage and in 53% in the second stage of labor. Maternal blood pressure and the condition of the newborn infants were unaffected by the analgesia. The rate of vacuum extraction was 12%. Complications were rare: nine patients had Horner's syndrome, 14 spinal headache, 5 slight neurological sequelae (all restored), one malignant hyperthermia, and in one patient, part of a cutoff catheter was left in the epidural space. Epidural blockade with this method was performed by senior anesthetists in 61% and by physicians in training in 39% of deliveries.