Low thoracic versus lumbar epidural anesthesia during the first phase of labor

Gutteling, J. (Jon) (2013) Low thoracic versus lumbar epidural anesthesia during the first phase of labor. thesis, Medicine.

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Abstract

Introduction: There are indications that the pain parturients experience during labor is one of the most intense pain experiences known. Epidural analgesia (“an epidural”) is a widely used central neuraxial block very suitable for perinatal analgesia. The most common used puncture site for epidural analgesia is in the lumbar region. Given the fact that most pain experienced during the first phase of labor originates from the low thoracic (T10- L1) spinal segments, we hypothesized that a epidural catheter placed in the lower thoracic epidural space would result in better analgesia and less instrumental assisted vaginal deliveries and caesarian sections than a catheter placed in the lumbar epidural space. Methods: To test this hypothesis, two studies were set up. Firstly a retrospective assessment of all epidurals during labor performed in the Deventer Hospital the past four years, to assess possible effects on primary labor outcome. Secondly a prospective observational study in which we included all parturients who received lumbar (L1-L5) or thoracic (T10-L1) epidural analgesia. We recorded pain using the visual analog scale (VAS) and the frequency of escape bolus requests during the first phase of labor. Results: The retrospective study had usable data from 1172 patients. Ninety-six received an epidural catheter in the thoracic region and 1096 a lumbar one. We found no significant differences in incidence of caesarian sections, spontaneous deliveries and instrumental deliveries. APGAR scores and total labor time were not significantly different. In the prospective study we included 44 patients. Thirteen had a thoracic and 31 a lumbar epidural catheter. While graphical representation did look promising, there were no significant differences in VAS scores, amount of escape bolus requests and time until escape bolus requests. A trend showing patients in the thoracic epidural group requiring less time between the puncture and transition to the delivery phase was seen. Conclusion: We found no significant difference in VAS pain scores reported by parturients with epidural catheters on lumbar or thoracic levels. Though there are indications that there are differences in the degree of analgesia and other labor parameters between the two epidural level modalities, such as a shorter total labor time and fewer escape bolus requests in the thoracic group, our results remain inconclusive. More research is needed to further objectify the difference in pain relief and labor outcome by thoracic and lumbar epidurals.

Item Type:	Thesis (Thesis)
Supervisor name:	Cobben, J.M.G. and Anesthesiology Department and Deventer Hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:42
Last Modified:	25 Jun 2020 10:42
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/340

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