Further Experience with Continuous Caudal Analgesia in Obstetrics

Abstract

Abstract 1. 1. Continuous caudal analgesia was attempted in 1,639 obstetric patients. Complete relief from pain was obtained in 1,525 patients. Forty patients had only partial relief from pain while seventy-four had no relief. Anatomical malformation was the main reason for the partial and complete failures. 2. 2. Early correction of occiput-posterior position and deep transverse arrest account for the increase in major operative deliveries and not the analgesic method used. Such early correction prevents soft tissue trauma, prevents pelvic relaxations and displacements and intracranial damage in the fetus. 3. 3. There was a higher percentage of major operative deliveries when continuous caudal analgesia was used. The complications during and following delivery, however, were much fewer than those found in the cases in which the major operative procedures were done with other forms of anesthesia. 4. 4. There is no delay in initiation of fetal respiration. Fetal distress is very rare. Ten stillbirths occurred; six were suspected before the analgesia was started and were confirmed by presence of maceration. Four stillbirths were due to obstetrical trauma. 5. 5. Some of the minor complications to the mother have been noted and discussed. There was one maternal death which occurred after delivery and after six hours of uneventful continuous caudal analgesia. It is doubtful that this method of analgesia was the cause of this death.