Return of pain in a well-working labor epidural – A cause of alert

Abstract

Epidural analgesia is considered as the most effective method of labor analgesia. Intravascular catheter migration is known to occur in patients in labor. There are methods to detect an intravascular migration such as epinephrine-containing test dose and negative aspiration, but these methods are unreliable and often misleading. Therefore, a high index of suspicion is required to avert the complications of local anesthetic systemic toxicity resulting from an intravascular administration of drugs given through the epidural catheter.

Keywords

• epidural analgesia: complications
• local anesthetics: systemic toxicity
• uterine blood flow determinants