Benhamou D, Mercier F J
Département d'Anesthésie-Réanimation, Hôpital Antoine-Béclère, Clamart.
Cah Anesthesiol. 1994;42(6):735-8.
Breech or twin delivery is a difficult obstetric situation in which both maternal and neonatal risks are increased and where the incidence of caesarean section and instrumental extraction is high. Epidural anaesthesia may worsen the obstetric situation especially if high doses of local anaesthetics are used resulting in a dense motor blockade. If, on the contrary, effective analgesia is obtained by the epidural injection of low concentrations of local anaesthetics especially with opiates, epidural anaesthesia may increase neither the duration of the second stage nor the incidence of caesarean delivery or forceps extraction and may rather improve neonatal outcome. Extension of the sensory block may be rapid, allowing obstetric intervention while maintaining maternal safety and comfort. For similar reasons and by using low dose techniques, epidural anaesthesia should not be anymore considered contra-indicated in the trial of labor after previous caesarean section.
臀位或双胎分娩是一种困难的产科情况，在此情况下，母婴风险都会增加，剖宫产和器械助产的发生率也很高。硬膜外麻醉可能会使产科情况恶化，尤其是在使用高剂量局部麻醉药导致严重运动阻滞的情况下。相反，如果通过硬膜外注射低浓度局部麻醉药（尤其是与阿片类药物合用）获得有效的镇痛效果，硬膜外麻醉既不会增加第二产程的时长，也不会增加剖宫产或产钳助产的发生率，反而可能改善新生儿结局。感觉阻滞的范围可能迅速扩大，从而在保证产妇安全和舒适的同时允许进行产科干预。出于类似原因并采用低剂量技术，硬膜外麻醉不应再被视为既往剖宫产术后试产的禁忌证。
