招聘講演（8）

Painless labor: rationale and French experience

Kamran SAMII, Toulouse, France

Pain during labor is important in 2/3 of the parturients and very severe in 20 % of them. Pain which is moderate and localized to T10-L1 during the first stage is enhanced by pharmacological induction of contraction and increases in intensity and extends in its topography during the second stage. The quality of analgesia obtained with parenteral opioids (meperidine), N2O and paracervical block is lower than the analgesia induced by epidural block. If low concentration of local anesthetics combined to opioids are used? epidural analgesia does not affect labor.

We have established an organization which allows all the parturients to be examined by an anesthesiologist during their pregnancy. Eclampsia, multiple gestations, breech presentation and previous cesarean section are not contra indications to epidural analgesia. The most frequent complication of epidural analgesia is inefficiency which is observed in almost 20 % of the parturients. Combination of opioids to local anesthetics has decreased the frequency of failure. Hypotension is frequent but easy to manage. Headache after accidental dural puncture is an indication of blood patch. Neurological complications are very rare but backache may be observed in 20 % of the parturients.

In France anesthesiologists are present 24h/24 for the OB Departments in 95 % of the hospital with > 2 000 births, regional anesthesia is used for 74 % of the parturients (62 % epidural and 12 % spinal) and general anesthesia only in 2% of the CS. When epidural analgesia is not used it is only in 3 % of the cases due to the absence of an anesthesiologist. In conclusion epidural analgesia is not only a method to have painless labor but also reduces the frequency of general anesthesia which is the major cause of maternal death. On the other hand it increases the general safety of parturient by generating the presence of anesthesiologists in the OB departments.