Most women who receive epidural pain relief during labour require additional epidural analgesia following the initial dose. This review examines the relative merits associated with current methods of epidural drug delivery when further analgesia is required. Apart from considerations of patient safety and convenience the review compares the relative flexibility in pain management which can be provided by these different regimens. It is postulated that patient satisfaction is enhanced when the mother has some personal control over the density of neural blockade provided by epidural analgesia.
MorganB.M., BulpittC.J., CliftonP., LewisP.J.Analgesia and satisfaction in childbirth (The Queen Charlotte's 1000 mother survey). Lancet1982; ii: 808–810.
2.
KitzingerS.Some Women's Experiences of Epidurals: a descriptive study.The National Childbirth Trust, London1987: 31–39.
3.
PaullJ.Rational choice of single shot or catheter techniques in epidural analgesia. In: Lectures in Anesthesia.World Federation of Societies of Anaesthesiologists, Amsterdam1981: 1–8.
4.
MoirD.D., DavidsonS.Postpartum complications of forceps delivery performed under epidural and pudendal nerve block. Br J Anaesth1972; 44: 1197–1199.
BrownridgeP., FrewinD.B.A comparative study of techniques of postoperative analgesia following caesarean section and lower abdominal surgery. Anaesth Intens Care1985; 13: 123–130.
LiD.F., ReesG.A.D., RosenM.Continuous extradural infusion of 0.0625% or 0.125% bupivacaine for pain relief in primigravid labour. Br J Anaesth1985; 57: 264–270.
12.
HansonB., Matouskova-Hanson. Continuous epidural analgesia for vaginal delivery in Sweden. Acta Anaesthesiol Scand1985; 29: 712–715.
13.
HansonA.L., HansonB.Continuous mini-infusion of bupivacaine into the epidural space during labor. Regional Anesthesia1985; 10: 139–144.
14.
BogodD.G., RosenM., ReesG.A.D.Extradural infusion of 0.125% bupivacaine at 10 ml h−1 to women during labour. Br J Anaesth1987; 59: 325–330.
15.
SmedstadK.G., MorisonD.H.A comparative study of continuous and intermittent epidural analgesia for labour and delivery. Can J Anaesth1988; 35: 234–241.
16.
JohnsrudM., DaleP.O., Lovland. Benefits of continuous infusion epidural analgesia throughout vaginal delivery. Acta Obstet Gynecol Scand1988; 67: 355–358.
17.
ChestnutD.H., VandewalkerG.E., OwenC.L., BatesJ.N., ChoiW.W.The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women. Anesthesiology1987; 66: 774–780.
18.
EwenA., McleodD.D., McleodD.M., CampbellA., TunstallM.E.Continuous infusion epidural analgesia in obstetrics. A comparison of 0.08% and 0.25% bupivacaine. Anaesthesia1986; 41: 143–147.
D'AthisF., MacheboeufM., ThomasH.Epidural analgesia with a bupivacaine-fentanyl mixture in obstetrics: comparison of repeated injections and continuous infusion. Can J Anaesth1988; 35: 116–122.
21.
ChestnutD.H., OwenC.L., OstmanL.G., BatesJ.N., ChoiW.W., GeigerM.W.Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology1988; 68: 754–759.
22.
JonesG., PaulD.L., EltonR.A., McLureJ.H.Comparison of bupivacaine and bupivacaine with fentanyl in continuous extradural analgesia during labor. Br J Anaesth1989; 63: 254–259.
23.
PhillipsG.Continuous infusion epidural analgesia in labor; the effect of adding sufentanil to 0.125% bupivacaine. Anesth Analg1988; 67: 462–465.
24.
BrownridgeP.Shivering related to epidural blockade with bupivacaine in labour, and the influence of epidural pethidine. Anaesth Intens Care1986; 14: 412–417.
25.
ReynoldsF., O'SullivanG.Epidural fentanyl and perineal pain in labour. Anaesthesia1989; 44: 341–344.
26.
MatovskaA.Epidural analgesia: continuous mini-infusion of bupivacaine into the epidural space during labour. Acta Obstet Gynecol Scand1979; 83(Suppl): 1–52.
27.
Australian Commonwealth Department of Health.Bedside drug delivery systems: what can and does go wrong. Therapeutic Device Bulletin, Canberra1987; 1: 2–3.
28.
GamblingD.R., YuP., ColeC., McMorlandG.H., PalmerL.A comparative study of patient controlled epidural analgesia (PCEA) and continuous infusion epidural analgesia (CIEA) during labour. Can J Anaesth1988; 35: 249–254.
BrownridgeP.Epidural bupivacaine-pethidine mixture: clinical experience using a low-dose combination in labour. Aust NZJ Obstet Gynaecol1988; 28: 17–24.
31.
CrawfordJ.S.Some material complications of epidural analgesia for labour. Anaesthesia1985; 40: 1219–1225.
32.
BrownridgeP.A three-year survey of an obstetric epidural service with top-up doses administered by midwives. Anaesth Intens Care1982; 10: 298–308.
