Regional blocks and their difficulties. Epidural.

The epidural must be regarded as a technique which requires a high level of understanding, and it should be used only by people who have received adequate training. When a spinal technique is thought to be preferable to general anaesthesia for surgical operations, the majority of cases would be managed more certainly and in greater safety by the subarachnoid technique. In obstetrics, the use of the epidural for relieving the pain of first stage labour, though excellent in experienced hands, is the situation above all others requiring great understanding on the part of doctors and nurses alike. The epidural (usually caudal) technique is the ideal method of analgesia for forceps delivery, but in view of the possibility of its associated side effects and complications arising while the operator is occupied with the obstetrical problem, the analgesia and the obstetrics should be managed by separate individuals.