Experiences with lumbar extradural analgesia for caesarean section.

The results of 324 Caesarean sections conducted under lumbar extradural block are discussed. In addition to pre-loading with fluid i.v. and the avoidance of aorto-caval compression, more recent modifications have been to administer bupivacaine in incremental doses, to be less concerned with the size of the total dose, and to provide the mother with supplementary oxygen until delivery. As a result of these modifications, the frequency of maternal discomfort and hypotension has been reduced, and the need for supplementary analgesia or a vasopressor has become a rarity. Administration of diazepam after delivery is still occasionally advisable. The technique has many advantages for both mother and infant and with a good obstetric service, few disadvantages. Prolongation of the interval between incision of the myometrium and delivery appears to be less detrimental to the infant than is the case when general anaesthesia is used.