What is Current mode of analgesia best for intrapartum pain relief: and explain in detail?
Ans. a (Epidural analgesia)LUMBAR EPIDURAL ANALGESIAIndications for lumbar epidural analgesia :# Pain in labor, management of the patient with preeclampsia who does not have a coagulation abnormality, management of labor in patients with certain cardiac lesions, and management of breech delivery.# Of the various pharmacologic methods of pain relief used in labor and delivery, regional analgesia techniques--spinal, epidural and combined spinal epidural (CSE) are the most flexible, effective, and least depressing to the CNS, allowing for an alert, participating mother and an alert neonate.Absolute contraindications:# Patient refusal, hemodynamic instability, infection at the anticipated site of puncture, and absence of resuscitation equipment.Relative contraindications:# Fever, preexisting CNS disease, hypovolemia, hypotension, lack of experience by the anesthetist, and blood coagulation defects.# Although an arbitrary platelet count of 100,000 per mm3 has been advocated as the lower limit for safe lumbar epidural analgesia, successful blocks without epidural bleeding complications have been obtained with platelet counts as low as 50,000 per mm3.Three principal advantages of lumbar epidural analgesia:# The parturient remains awake and cooperative.# The incidence of complications is very low when the technique is used correctly.# Once an epidural catheter is in place, it can be used to provide analgesia or anesthesia for a vaginal or cesarean delivery.The disadvantages of lumbar epidural analgesia:# The possibility of poor perineal analgesia# The presence of "hot spots", where analgesia is insufficient# Delayed onset of action# Technical difficulty (Technical failure occurs in approximately 4% of cases)# Intravascular injection# Accidental dural puncture