Continuous epidural analgesia for vaginal delivery in Sweden. Report of a nationwide inquiry.

Volumetric pump infusion of bupivacaine into the epidural space for pain relief during labour was introduced in Sweden in 1976. Since then the method has gained widespread use. A questionnaire concerning the use of epidural analgesia (EDA) in 1982 was sent to anaesthetists at all Swedish maternity clinics. During the year, 84 188 vaginal deliveries were registered. EDA for pain relief was performed in 11 324 of them (13.4%). At that time, EDA was available in 56 out of 66 clinics. In almost all clinics (52/56), bupivacaine plain 2.5 mg/ml was used for the blocks. Analgesia was maintained by volumetric pump infusion of bupivacaine in 28 units, by intermittent technique in 25, and both techniques were used in three units. No clinic had abandoned the infusion technique once it had been introduced. Experience from both techniques showed the infusion technique to be more convenient as it produces stable analgesia, is easily conducted and can be supervised by midwives. No complication which could be connected with infusion technique was noted. Maternal hypotension was rare and the instrumental delivery rate was low. The technique proved to be a valuable aid to the organisation of a 24-h service for obstetric analgesia, without requiring any increase in staff.