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Can J Anesth/J Can Anesth (2010) 57:103106
DOI 10.1007/s12630-009-9229-0
EDITORIALS
Walking epidurals for labour analgesia: do they benet anyone?
Roanne Preston, MD
Published online: 6 January 2010 Canadian Anesthesiologists Society 2009
The walking epidural rst appeared in the early 1990s. In some ways, it tested our widely held beliefs about how to provide effective and safe labour epidural analgesia and responded to womens requests to have effective labour analgesia without being conned to bed. In the rst versions of the walking epidural, the combined spinal-epidural (CSE) technique was used. It provided initial analgesia with intrathecal narcotic, which was followed by a more standard continuous epidural infusion.1,2 This novel technique challenged our assumptions about the amount of neuraxial medication needed to initiate and maintain labour analgesia. Many labour analgesia studies ensued that resulted in signicant changes to both the technique and the dosing strategies, and they led to a deeper understanding of the way in which local anesthetics and opioids work alone and synergistically in the neuraxium. Critical assessment of ambulation in labour with an epidural in situ has provided enormous benet to women in labour, has changed how anesthesiologists provide labour epidural analgesia, and has added to the body of literature to convince our skeptical colleagues in obstetrics that epidurals dont necessarily mean an operative delivery. The end result of this scientic activity is patient-controlled labour epidural analgesia with low-dose solutionsthere are so many benets in that simple phrase. So, why has the enthusiasm for walking epidurals faded?
While it is true that ambulation per se has not been shown to alter labour outcome,37 maintaining mobility appeals to women although they may be at the point of requiring neuraxial analgesia. The fact that they may not take full advantage of this opportunity does not negate its other benet of minimizing motor block. It is also true that the mobile mom can create more work for staff; however, once anesthesiologists establish management and safety protocols for ambulation, the added work belongs to the nurse and/or the midwife, many of whom support maintaining mobility.8 Safety of the perambulating parturient with an epidural has been establishedher balance is just as good as any pregnant womans is at term,9,10 blood pressure is possibly more stable than in the...