Regional Analgesia in Obstetrics A Millennium Update

At the turn of the century it is appropriate to take stock of this relatively young but rapidly developing subject. For the first time, this book brings together information on the status of obstetric regional analgesia in many parts of the globe, and on the intriguing variability of maternal attitudes towards it. Advances in the field over the last decade in new applications, new drugs and techniques and new research tools are also reviewed. Controversial topics such as the effects of regional analgesia on the progress of and outcome of labour, the indications, contraindications and complications, and the place of regional anaesthesia for operative delivery are discussed by numerous experts in the field. The problem of consent and medicolegal aspects are also addressed. Regional Analgesia in Obstetrics should be read by all those involved in the medical care of women in childbirth. Professor Felicity Reynolds is Emeritus Professor of Obstetric Anaesthesia, St Thomas' Hospital, London, UK.

Section 1: Use of regional analgesia — an international perspective.- 1. Anaesthesia care for obstetric patients in the United States.- 2. Obstetric anaesthesia and analgesia in Latin-America.- 3. Pain relief in labour in Great Britain and Ireland.- 4. Regional analgesia in Scandinavia.- 5. Obstetrics anaesthesia practices in some countries in Western Europe.- 6. Use of regional anaesthesia in some Central and Eastern European countries.- 7. Obstetric anaesthesia practices in Turkey.- 8. Regional anaesthesia and analgesia for obstetrics in Australia and New Zealand.- 9. Regional analgesia in obstetrics in the Far East.- Section 2: Developments in techniques in the past decade.- 10. Mobile epidural techniques and new drugs in labour.- 11. Spinal analgesia in labour.- 12. Top-ups versus infusions and patient-controlled epidural analgesia (PCEA).- 13. Before the block: fluid preloading and testing the catheter.- 14. Clinical trials: what should we assess?.- 15. Clinical trials: up-down sequential allocation.- Section 3: Current indications for regional analgesia in labour.- 16. Current indications for regional analgesia: obstetric complications.- 17. Current indications for regional analgesia and anaesthesia: intercurrent medical disease.- 18. Current indications for regional analgesia in labour: what is the place of epidural analgesia in normal labour?.- Section 4: Effects of regional analgesia.- 19. The benefits of labour analgesia.- 20. Effects of regional analgesia on labour and delivery.- 21. Neonatal effects of regional analgesia.- Section 5: Operative delivery.- 22. Regional anaesthesia for operative delivery.- 23. Postoperative pain relief.- Section 6: Complications of regional analgesia.- 24. Immediate complications of regional blockade in obstetrics.- 25. Duralpuncture and headache.- 26. Long term sequelae of childbirth: backache.- 27. Long term neurological sequelae of childbirth.- 28. The impact of regional anaesthesia on maternal mortality.- 29. Contraindications to regional analgesia in labour?7.- 30. Medicolegal implications.- 31. Information and consent.