International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1996
Anaesthetic characteristics and long-term backache after obstetric epidural anaesthesia.
Anaesthetic casenotes of 4700 women who had epidural anaesthesia for deliveries between 1978-1985 were examined to look for associations between various epidural characteristics and subsequently reported long-term backache. The data on long-term backache came from a postal questionnaire sent to the women. ⋯ There were no relationships between long-term backache and the duration of the epidural or various indicators of the extent of motor or sensory block. Within the range of local anaesthetic concentration levels used in this series, the extent of block did not seem to affect backache, but the effect of minimal motor block with corresponding increased mobility, such as is available with low concentration anaesthetics mixed with opiates, merits further study.
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In a study of the factors involved in the occasional failure of continuous obstetric epidural blockade, contrast injections through epidural catheters and radiographic screening were undertaken in 35 postpartum patients. The two major causes of inadequate block were found to be transforaminal escape of the catheter tip, and persistent unilateral block associated with an obstructive barrier in the epidural space. Recommendations for overcoming these problems are discussed.