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  30/09/20091 The effect of epidural analgesia on labour outcome   Dr. Tarek Ansari, FFARCSIChief of ServicesDepartment of AnaesthesiaCorniche Hospital Abu Dhabi The srcin of metameric anaesthesiaPages or Dogliotti Pages F. Anestesia Metamerica. Rev San Militar (Madrid) 1921; 11: 3-30.Dogliotti A M. A new method of block anesthesia: segmental peridural spinal anesthesia. Am J Surg 1933; 20: 107-118. Fidel Pages 1886-1923Achile M Dogliotti 1897-1996  30/09/20092 Pioneers of obstetric analgesia  Graffagnino P, Seyler W: Epidural anaesthesia in obstetrics. Am J Obstet Gynaecol 35: 597-600, 1938 . . 1916-1984 Dr. Andrew Doughty 1916 - Physician Alert  Epidural is safe and may be a superior labor analgesic when compared with narcotics; however, patients should be informed that epidural analgesia may increase the risk of Cesarean birth in first labors. uene: Delay placement of epidural until five centimeters of cervical dilation has occurred to reduce the risk of Cesarean section. August 1 1996  30/09/20093 How did it all start? Thorp, J A et al .The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women.Am J Obstet Gynecol. 1989; 161(3): 670-5ThorpJA et al.Epidural analgesia and cesarean section for dystocia : rs acors n nuparas.m pernaoogy.; :-Thorp, JA et al. The effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial. Am J Obstet Gynecol 1993 196(4):851-858. PethidineEpidural Duration of 1st stage (min) 519676  uraon o n sage mnOxytocin augmentation (%) 26.758.3 Malpositions foetal head (%) 4.418.8 Spontaneous delivery (%) 86.756.2 Assisted vaginal delivery (%) 11.118.8 Caesarean section (%) 2.225 Thorp, JA et al. The effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial. Am J Obstet Gynecol 1993 196(4):851-858.  30/09/20094  - Epidural analgesia had no statistically significant impact on the risk of caesarean section, or long-term backache and did not appear to have an immediate effect on analgesia in labour neonatal status as determined by Apgar scores. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4.Study InterventionBofill 1997Bup. 0.25% / Bup. 0.125% +Fent 1.5 mcg/mlClark 1998Bup. 0.25% / Bup. 0.125% +Fent 1. mcg/mlDickinson 2002CSE / Bup. 0.125%. Gambling 1998Bup. 0.25% / Bup. 0.125% +Fent 2 mcg/mlGrandjean1979Lidocaine1.5%Head 2002Bup. 0.25% / Bup. 0.125% +Fent. 2 mcg/mlHogg 2000Bup. 0.25% / Bup. 0.125% +Fent. 2 mcg/mlHowell 2001Bup. 0.25% / Bup. 0.25% +Fent. 2 mcg/mlJain 2003Bup. 0.15% /Bup. 0.1%+Fent. 1 mcg/mlLong 2003CSE/Ropivacaine0.1%+Fent. 1.5 mcgLoughan 2000Bup. 0.25% / Bup. 0.125% +Fent. 2 mcg/mlLucas 2001Bup. 0.25% / Bup. 0.125% +Fent. 2 mcg/mlMorgan-Ortiz 1999No informationMuir 1996Bup. 0.125% /Bup. 0.125 %+Fent. 1 mcg/mlMuir 2000Bup. 0.08% + Fent. 1.67 mcg/mlNikkola1997Bup. 0.5%Philipsen1989Bup. 0.375%Sharma 1997Bup. 0.125% +Fent. 2 mcg/mlSharma 2002Bup. 0.25% / Bup. 0.0625% +Fent. 2 mcg/mlThalme1974Bup. 0.25%Thorp 1993Bup. 0.25%
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