Why epidurals do not always work

Abstract

The overwhelming majority of epidural catheters placed for labor provide satisfactory analgesia. There are, however, times when the catheter is not sited within the epidural space correctly, the patient's neuraxial anatomy is problematic, or a patient's labor progresses more quickly than expected by the anesthesiologist, and the epidural block does not set up on time. In this article, the basics of neuraxial labor analgesia, the causes of its failure, and the strategies anesthesiologists employ to rescue poorly functioning catheters are reviewed.

Keywords: Combined spinal epidural technique; Dural puncture; Epidural failure; Neuraxial labor analgesia.

Figures

Figure 1

Epidural needle in epidural space. From Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348:319–332. Copyright © Massachusetts Medical Society. All rights reserved.

Figure 2

Catheter placement into epidural space. From Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348:319–332. Copyright © 2003 Massachusetts Medical Society. All rights reserved.

Figure 3

Combined spinal epidural technique. From Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348:319–332. Copyright © 2003 Massachusetts Medical Society. All rights reserved.