CONTINUOUS INFUSIONS OF LOCAL-ANESTHETICS AND NARCOTICS FOR EPIDURAL ANALGESIA IN THE MANAGEMENT OF LABOR

It appears that complete analgesia for labor using epidural and subarachnoid opiates alone, with a minimum of side effects, remains an unfulfilled goal. However, the combination of extremely small doses of local anesthetics and opiate drugs seems to provide excellent analgesia with a minimum of side effects. This concept of combined opiates and local anesthetics corresponds to that of modern "balanced" general anesthesia, in which small amounts of several drugs are used to provide excellent anesthesia with a minimum of the side effects seen with large doses of any single drug. In my opinion, this "balanced" regional anesthesia holds great promise for the future, especially with the discovery of new drugs that produce spinal analgesia through a variety of mechanisms. These drugs include catecholamines, clonidine, GABA agonists, substance P antagonists, prostaglandin synthetase inhibitors, and many other drugs capable of altering neural transmission in such a way that analgesia results. Obviously, labor analgesia is one area in which these combinations will be explored extensively, and the next few years should be very exciting ones. © 1990 by Little, Brown and Company.