Safe Practice of Neuraxial Labor Analgesia

Abstract

Recent anesthesia-related maternal deaths have been found to be caused by local anesthetic systemic toxicity（LAST）or respiratory arrest due to high spinal anesthesia, all during labor epidural analgesia. Safety of neuraxial anesthesia must be the prerequisite for providing analgesia during labor for healthy parturients. Adequate anesthesiology training is the key for safe labor epidural analgesia, not only for successful procedures but also for management of critical events such as LAST and respiratory arrest. Both LAST and high spinal anesthesia should be prevented by the administration of a test dose upon epidural catheter placement, followed by small incremental dosing of local anesthetic throughout the course of labor. Because labor epidural analgesia（LEA）is often provided when inducing labor with oxytocic in Japan and LEA is associated with increased incidence of instrumental vaginal delivery, obstetric care providers including midwives must be prepared to manage postpartum hemorrhage.