Name of the Procedure

Neuraxial labor analgesia/anesthesia for planned vaginal delivery (including repeat subarachnoid needle placements and drug injections, and replacement of epidural catheter during labor).
Common Names: Epidural anesthesia, Spinal anesthesia, Combined spinal-epidural anesthesia.

Summary

Neuraxial labor analgesia/anesthesia involves placing a needle and, typically, a catheter near the spinal cord to administer pain-relieving medications throughout labor. It can be performed via epidurals, spinal injections, or a combination of both.

Purpose

Medical Condition or Problem: To manage pain during labor and delivery. Goals and Expected Outcomes: Provides significant pain relief while allowing the mother to remain awake and actively participate in childbirth.

Indications

• Severe labor pain unresponsive to other pain relief methods.
• Pre-existing medical conditions contraindicating other forms of pain relief.
• Patient preference for pain management during labor.
• Complications requiring potential surgical intervention during delivery.

Preparation

• Pre-Procedure Instructions: Usually, no solid food 6-8 hours before the procedure. Clear liquids up to 2 hours prior may be allowed.
• Diagnostic Tests/Assessments: Routine assessments may include blood tests to check coagulation levels and a review of medical history for any contraindications.

Procedure Description

1. Initial Setup: The patient will be positioned seated or lying on their side.
2. Skin Preparation: The lower back area is cleaned with an antiseptic solution.
3. Local Anesthesia: A small amount of local anesthetic is injected to numb the area where the neuraxial needle will be inserted.
4. Needle Insertion: A needle is inserted either into the epidural space (for an epidural) or the subarachnoid space (for spinal anesthesia).
5. Catheter Placement: For epidurals, a catheter is threaded through the needle into the epidural space and left in place.
6. Medication Administration: Pain-relieving medication is administered through the needle or catheter.
7. Monitoring and Adjustment: The healthcare team will monitor the patient and adjust dosages as needed.

Duration

The initial procedure to place the epidural or spinal needle/catheter typically takes about 10-30 minutes. Continuous monitoring and adjustments last throughout labor.

Setting

Usually performed in a hospital labor and delivery unit.

Personnel

• Anesthesiologist or nurse anesthetist.
• Labor and delivery nurse.
• Obstetrician or midwife.

Risks and Complications

• Common Risks: Low blood pressure, headache, nausea.
• Rare Risks: Infection, nerve damage, severe headache (spinal headache), allergic reactions.
• Management: Medical interventions available to manage any of these complications should they arise.

Benefits

• Expected Benefits: Effective pain relief during labor, ability to remain awake, potential for dose adjustment as labor progresses.
• Realization Time: Pain relief typically begins within 10-15 minutes after medication administration.

Recovery

• Post-Procedure Care: Monitoring in the labor and delivery unit; fluids may be administered through an IV to manage blood pressure.
• Expected Recovery Time: Immediate pain relief; monitoring continues until the postpartum period.
• Restrictions/Follow-Up Appointments: Limited movement until anesthesia wears off; postpartum check for recovery progress by obstetric care provider.

Alternatives

• Other Treatment Options: IV pain medications, nitrous oxide, non-pharmacological methods (breathing techniques, hydrotherapy).
• Pros and Cons: Alternatives may offer less invasive options but generally provide less effective pain relief.

Patient Experience

• During Procedure: Mild discomfort at the needle insertion site; a sensation of pressure rather than pain.
• After Procedure: Significant pain relief; may feel numbness in the lower half of the body. Patient may need help with mobility initially post-birth; sensation typically returns within a few hours. Pain management with additional medications as needed.

By outlining all these aspects, patients and healthcare providers can have a comprehensive understanding of neuraxial labor analgesia/anesthesia for planned vaginal delivery.