Perspective Chapter: Epidural Administration-New Perspectives and Uses

Neuraxial techniques are commonplace in labor analgesia. Techniques for labor analgesia range from intrathecal and epidural anesthesia to peripheral nerve blocks, nitrous oxide, intravenous infusions, and acupuncture. The epidural approach is the most popular as it allows for local anesthetics to diffuse into the intrathecal space along with repeated or continuous doses of medication for labor and primary anesthetic for surgeries. The epidural technique affects differing spinal nerves (i.e., pain, autonomic, sensory, and motor) with varied effects depending on the concentration and volume of LA used. Adverse effects do exist following these techniques with hypotension being a major concern. A multitude of anesthetic agents can be given in the epidural; opioids are the most frequently used local anesthetic adjuvants. Alpha 2 adrenoreceptor agonists are also used as local anesthetic adjuvants. Although not performed routinely, peripheral nerve blocks play a complementary and supplementary role in epidural analgesia and anesthesia. There are absolute and relative contraindications to epidural anesthesia. Alternatives to neuraxial anesthesia that can be offered include infusion of ultrashort acting opioids, nitrous oxide, opioid agonist-antagonists, ketamine, TENS, and acupuncture. Local Anesthetic Systemic Toxicity may be more prevalent in the pregnant.