The use of adrenaline in dilution of 1: 300.000 and below significantly increases the duration of the blockade and its quality, while also local anesthetics act faster.
Some authors do not recommend adding adrenaline to a solution of a local anesthetic for epidural analgesia of labor, firstly , for fear of slowing down the labor under the action of adrenaline absorbed into the bloodstream, secondly, because of the possibility of excessive deepening of anesthesia (a motor block is possible), thirdly , because of the unreliability of the test dose with adrenaline, because during labor the mother has tachycardia, and it is impossible to say why the pulse accelerated — from pain or from adrenaline, introduced into the epidural vein. But most authorities recommend adding adrenaline, as when used in breeding
1: 200.000 – 1: 400.000 (1-2 drops per 20 ml of local anesthetic solution) it does not affect uterine contractility or placental blood circulation, and the quality of analgesia is better with a lower concentration of local anesthetic.
ADDING FENTANILE
Adding a small dose to the local anesthetic (no more than one ampoule, and preferably half a ampoule — 1 ml) of fentanyl has two advantages: first , the quality of epidural analgesia is improved without fetal suppression and the complications inherent in epidural morphine second , fentanyl in epidural single topical solution anesteti is officially recognized indicator (cm. above the subsection “Intoxication local anesthetic”) intra- vascular ingress of this solution, since the intravenous administration of 100 micrograms (one vial) in obstetric patients fentanyl in ezhno is drowsy ness.
COMPLICATIONS Pain during childbirth is the norm, but no mother died from this pain.
The description of the numerous components and schemes of the epidural both illnesses of the childbirth in no way is a call for the application of all of the above. Epidural anesthesia may itself hath many complications (see. The “Symptoms When entering into the epidural space,” “PROBLEMS DURING MAINTENANCE epidural anesthesia”, “long-term complications of epidural anesthesia”), Long (with Kate Intermediate location) epidural analgesia is more risk factors, and the more different drugs used for it — the higher the risk (see section “EXTRA-OPERATIONAL EPIDURAL ANALGESIA”). Although native pain, in addition to mental suffering for the mother, causes considerable stress for her and the fetus, this pain, in itself, is unlikely to lead to fatal complications (see epigraph). And invasive, rather aggressive methods of anesthesia can lead.