Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Jun 2000
Review[Failure of obstetric epidural analgesia and its causes].
The frequency of failure to establish and maintain an epidural block is low in Spain for surgery but higher in obstetrics. The reasons are many, but noteworthy factors are the prior experience of the anesthesiologist, the anatomical features of the patient and the type of material used. However, we lack clinical and anatomical studies of the epidural space that would allow us to come to definitive conclusions. ⋯ The anesthesiologist should avoid inserting too much of the epidural catheter and should assure firm support, checking it periodically and taking into account the patient's position. Finally the anesthetic dose should be adjusted to the progress of labor. The risk of incomplete analgesia and the possible need to insert a second epidural catheter must be discussed with the patient during preanesthetic evaluation.