'WALKING EPIDURAL' BLOCKS LABOR PAIN BUT LETS MOM MOVE

NEW ORLEANS -- A technique called combined spinal-epidural (CSE) analgesia eliminates early labor pain in a fraction of the time of conventional labor analgesia and does so without impairing a woman's ability to walk around in the birthing suite if she chooses, according to researchers from the Columbia University College of Physicians and Surgeons, New York, N.Y.

Nicknamed the "walking epidural," the technique selectively blocks only the nerves supplying the abdominal region, allowing a woman to be awake and comfortable during childbirth.

"Until recently, pregnant women opting for pain relief during early labor had two choices: total pain relief with leg numbness or incomplete pain relief without leg numbness," said David J. Birnbach, M.D., at the American Society of Anesthesiologists annual meeting. "CSE totally blocks pain during the first three hours after placement, often the most painful hours, but without any of the body numbness of conventional labor analgesia."

Research presented by Dr. Birnbach at the meeting supports CSE's desirability as an alternative to traditional methods. The study of 700 laboring women who received conventional epidural analgesia and 1,000 who received CSE showed no major complications in either group but faster pain relief and greater patient satisfaction with CSE. The study was performed at Columbia University's St. Luke's-Roosevelt Hospital Center in New York City.

Pain relief with CSE begins in less than two minutes, whereas pain relief with traditional labor analgesia starts in 20 minutes, Dr. Birnbach said. And by allowing the woman to continue walking safely rather than confining her to bed during the entire labor, the technique helps reduce boredom and anxiety, he said.

CSE may be especially attractive to first-time mothers, who commonly experience severe pain during the first few hours of labor, he said.

Also known as the "double needle technique," CSE combines the superior pain relief of a spinal injection with the flexibility of epidural analgesia.

After numbing the skin with a local anesthetic, the anesthesiologist inserts a thin needle into the outer layer of the spinal column, called the epidural space. A second needle inserted directly through the first is directed into a deeper region of the spinal column, called the spinal space, where a fast-acting anesthetic agent is delivered. In this way, the patient feels one injection only, and the injection does not hurt because the anesthesiologist has previously numbed the area.

The anesthesiologist then threads a catheter (fine tube) through the epidural needle into the epidural space. Other medications can be delivered quickly through the catheter in the event of an emergency cesarean section delivery or if, after three hours, the woman has not yet delivered and requests more medication. Additional medication delivered after the first three hours can sometimes produce leg numbness, Dr. Birnbach noted.

Although anesthesiologists began using CSE 10 years ago, the technique has gained popularity in obstetrics only recently, thanks to new, fast-acting pain medications and rounded-end, "pencil point" needles. The needles helped lower the incidence of headaches sometimes associated with spinal anesthesia.

Copyright (c) 1996 American Society of Anesthesiologists. All rights reserved.