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British Journal of Anaesthesia, 1994, Vol. 73, No. 4 540-542
© 1994 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Posterior column sensory impairment during ambulatory extradural analgesia in labour

D. BUGGY, MSC, MRCPI, DME, N. HUGHES, FFARCSI, DABA and J. GARDINER, FFARCSI, FRCA

Department of Anaesthesia, Rotunda Hospital Dublin, Ireland
Department of An aesthesia, St James' Hospital Dublin, Ireland

Present address, for correspondence: Department of Anaesthesia, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland

Ambulatory or ";walking" extradural analgesia in labour has recently gained popularity because of preservation of motor function and subjective somatic sensation in the lower limbs, resulting in increased maternal satisfaction. This is produced by combining dilute concentrations (e.g. 0.1%) of bupivacaine with opioids. Detailed clinical neurological examination after mobile extradural analgesia has not been reported. We have investigated the effect of 0.1% bupivacaine 15 ml and fentanyl 2µ ml–1 on motor and sensory function in the lower limbs in 50 primigravidae requesting extradural analgesia in labour. This was performed before and 30 min after confirming placement of a lumbar extradural catheter. While power, co-ordination and reflexes in all lower limb muscle groups remained within normal limits, 66% (n=33) developed abnormal distal proprioception, 44% (n=22) had a positive Romberg's sign and 38% (n=19) had altered vibration sense. Moreover, 44% (n=22) said that their legs felt different on standing and they did not feel confident walking unaccompanied. However, this subjective perception correlated poorly with the presence of posterior column sensory signs. Although there was a reduction in pain scores on a visual analogue scale after 30 min (mean 8.85 (SEM 0.3) vs 3.06 (0.32); P<0.0001), pain increased within 60 min (5.77 (0.45); P<0.001).


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