Skip to main content
SpringerLink
Log in

Epidural Analgesia for Childbirth

Effects of Newer Techniques on Neonatal Outcome

  • Review Article
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

New low-dose, local anesthetic-opioid combinations, combined spinal epidural analgesia, and new anesthetic drugs, such as ropivacaine and levobupivacaine, have modified the anesthetic practice in obstetric labor analgesia. These new analgesic techniques have less or no neonatal effects when compared with traditional epidural labor analgesia. They also have less effect on mode of delivery, which may in turn affect neonatal outcome.

The use of very diluted or low concentrations of local anesthetic solutions may reduce their placental passage and thus the possible subtle neonatal effects. Small doses of epidural or spinal opioids alone or combined with low doses of local anesthetics does not affect the well-being of the neonate at birth. When considering the neonatal outcome, combined spinal epidural analgesia is as well tolerated as low-dose epidural analgesia.

Transient fetal heart rate changes have been described immediately after the administration of intrathecal or epidural opioids. Maternal hypotension may also occur at the onset of epidural analgesia. Whether the occurrence of transient fetal heart rate changes or maternal hypotension immediately after the epidural block may influence the neonatal outcome at birth needs verification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. Bleyaert A, Soetens M, Vaes L, et al. Bupivacaine 0.125 per cent, in obstetric epidural analgesia: experience in three thousand cases. Anesthesiology 1979; 51: 435–8

    Article  PubMed  CAS  Google Scholar 

  2. Hurley RJ, Johnson MD. Maternal, fetal and neonatal effects of intraspinal opioids. In: Van Zundert A, Ostheimer GW, editors. Pain relief and anesthesia in obstetrics. New York (NY): Churchill Livingstone, 1996: 229–34

    Google Scholar 

  3. Richards MP. Effects of analgesics and anesthetics given in childbirth on child development. Neuropharmacology 1981; 20: 1256–9

    Google Scholar 

  4. Brazelton TB. Neonatal behavioral assessment scale. London: William Heineman Medical Books, 1973

    Google Scholar 

  5. Scanlon JW, Brown WU, Weiss JB, et al. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974; 40: 121–8

    Article  PubMed  CAS  Google Scholar 

  6. Amiel-Tison C, Barrier G, Shnider SM, et al. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full-term newborns. Anesthesiology 1982; 56: 340–50

    Article  PubMed  CAS  Google Scholar 

  7. Kraemer HC, Korner AF, Thoman EB. Methodological considerations in evaluating the influence of drugs used during labor and delivery on the behavior of the newborn. Dev Psychol 1972; 6: 128–34

    Article  Google Scholar 

  8. Brockhurst NJ, Littleford JA, Halpern SH, et al. The neurologic and adaptive capacity score: a systematic review of its use in obstetric anesthesia research. Anesthesiology 2000; 92: 237–46

    Article  PubMed  CAS  Google Scholar 

  9. Belfrage P, Boreus LO, Hartvig P, et al. Neonatal depression after obstetrical analgesia with pethidine: the role of the injection-delivery time interval and the plasma concentrations of pethidine and norpethidine. Acta Obstet Gynaecol Scand 1981; 60(1): 43–9

    Article  CAS  Google Scholar 

  10. McGrady EM. Extradural analgesia: does it affect progress and outcome of labour? Br J Anaesth 1997; 78: 115–7

    Article  PubMed  CAS  Google Scholar 

  11. Miller AC. The effects of epidural analgesia on uterine activity and labor. Intern J Obstet Anesth 1997; 6: 2–18

    Article  CAS  Google Scholar 

  12. Fogel ST, Shyken JM, Leighton BL, et al. Epidural labor analgesia and the incidence of cesarean delivery for dystocia. Anesth Analg 1998; 87: 119–23

    PubMed  CAS  Google Scholar 

  13. Segal S, Su M, Gilbert P. The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis. Am J Obstet Gynecol 2000; 183: 974–8

    Article  PubMed  CAS  Google Scholar 

  14. Halpern S, Leighton B, Ohlsson A, et al. Effect of epidural vs parenteral opioid analgesia on the progress of labor. JAMA 1998; 280: 2105–10

    Article  PubMed  CAS  Google Scholar 

  15. Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet 2001; 3581: 19–23

    Google Scholar 

  16. Reynolds F, Sharma S, Seed PT. Epidural analgesia and funic acid-base balance: a meta-analysis [abstract]. Anesthesiology 2001; 94: A9

    Google Scholar 

  17. Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a metaanalysis. Anesth Analg 2003; 96: 1473–9

    Article  PubMed  CAS  Google Scholar 

  18. Halpern SH, Breen TW, Campbell DC, et al. A multicentre, randomised, controlled trial comparing bupivacaine with ropivacaine for labor analgesia. Anesthesiology 2003; 98: 1431–5

    Article  PubMed  CAS  Google Scholar 

  19. Zamora JE, Roaseg OP, Lindsay MP, et al. Haemodynamic consequences and uterine 0.5 or 1.0 litre crystalloid infusion before obstetric epidural analgesia. Can J Anaesth 1996; 43: 347–52

    Article  PubMed  CAS  Google Scholar 

  20. Norris M, Fogel S, Conway-Long C. Combined-spinal-epidural versus epidural labor analgesia. Anesthesiology 2001; 95: 913–20

    Article  PubMed  CAS  Google Scholar 

  21. Gautier PE, De Kock M, Fanard L, et al. Intrathecal clonidine combined with sufentanil for labor analgesia. Anesthesiology 1988; 88: 651–6

    Article  Google Scholar 

  22. Loughnan BA, Carli F, Romney M, et al. Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour. Br J Anaesth 2000; 84: 715–9

    Article  PubMed  CAS  Google Scholar 

  23. Fisher C, Blanie O, Jaouen E, et al. Ropivacaine, 0.1% plus sufentanil, 0.5 µg/ml, versus bupivacaine, 0.1% plus sufentanil, 0.5 µg/ml, using patient-controlled epidural analgesia for labor. Anesthesiology 2000; 92: 1588–93

    Article  Google Scholar 

  24. Finegold H, Mandell G, Ramanathan S. Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125%-fentanyl infusions for epidural labour analgesia. Can J Anesth 2000; 47: 740–5

    Article  PubMed  CAS  Google Scholar 

  25. Campbell DC, Zwack RM, Crone LL, et al. Ambulatory labor epidural analgesia: bupivacaine versus ropivacaine. Anesth Analg 2000; 90: 1384–9

    Article  PubMed  CAS  Google Scholar 

  26. Writer WD, Stienstra R, Eddlestone JM, et al. Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. Br J Anaesth 1998; 81: 713–7

    Article  PubMed  CAS  Google Scholar 

  27. Fernandez-Guisasola J, Serrano ML, Cobo B, et al. A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg 2001; 92: 1261–5

    Article  PubMed  CAS  Google Scholar 

  28. Capogna G, Celleno D, Lyons G, et al. Determination of the minimum analgesic concentration (MLAC) of epidural ropivacaine in labor. Br J Anaesth 1999; 82: 371–3

    Article  PubMed  CAS  Google Scholar 

  29. Stienstra R, Jonker TA, Bourdrez P, et al. Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blind comparison. Anesth Analg 1995; 80: 285–9

    PubMed  CAS  Google Scholar 

  30. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59: 551–79

    Article  PubMed  CAS  Google Scholar 

  31. Vercauteren MP, Hans G, De Decker K, et al. Levobupivacaine combined with sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic bupivacaine. Anesth Analg 2001; 93: 996–1000

    Article  PubMed  CAS  Google Scholar 

  32. Connelly NR, Parker RK, Vallurupalli V, et al. Comparison of epidural fentanyl versus epidural sufentanil for analgesia in ambulatory patients in early labor. Anesth Analg 2000; 91: 374–8

    PubMed  CAS  Google Scholar 

  33. Capogna G, Parpaglioni R, Lyons G, et al. Minimum analgesic dose of epidural sufentanil for first-stage labor analgesia: a comparison between spontaneous and prostaglandin-induced labors in nulliparous women. Anesthesiology 2001; 94: 740–4

    Article  PubMed  CAS  Google Scholar 

  34. Fontaine P, Adam P. Intrathecal narcotics are associated with prolonged second stage labor and increased oxytocin use. J Fam Pract 2000; 49: 515–20

    PubMed  CAS  Google Scholar 

  35. Capogna G, Celleno D, Tomassetti M. Maternal analgesia and neonatal effects of epidural sufentanil for cesarean section. Reg Anesth 1989; 14: 282–7

    PubMed  CAS  Google Scholar 

  36. Noble OW, Morrison LM, Bruckway MS, et al. Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for anaesthesia in elective caesarean section. Br J Anaesth 1991; 66: 645–50

    Article  PubMed  CAS  Google Scholar 

  37. Carrie LE, O’Sullivan GM, Seegobin R. Epidural fentanyl in labour. Anaesthesia 1981; 36: 965–9

    Article  PubMed  CAS  Google Scholar 

  38. Murphy JD, Henderson K, Bowden MI, et al. Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction. BMJ 1991; 302: 564–7

    Article  PubMed  CAS  Google Scholar 

  39. Vertommen JD, Vandermeulen E, Van Aken H, et al. The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and the incidence of instrumental deliveries. Anesthesiology 1991; 74: 809–14

    Article  PubMed  CAS  Google Scholar 

  40. Ruban P, Sia AT, Chong JL. The effect of adding fentanyl to ropivacaine 0.125% on patient-controlled epidural analgesia during labour. Anaesth Intensive Care 2000; 28: 517–21

    PubMed  CAS  Google Scholar 

  41. Palm S, Gertzen W, Ledowski T, et al. Minimum local analgesic dose of plain ropivacaine versus ropivacaine combined with sufentanil during epidural analgesia for labour. Anaesthesia 2001; 56: 526–9

    Article  PubMed  CAS  Google Scholar 

  42. Lyons G, Columb MO, Hawthorne L, et al. Epidural pain relief in labour: bupivacaine sparing by epidural fentanyl is dose dependent. Br J Anaesth 1997; 78: 493–7

    Article  PubMed  CAS  Google Scholar 

  43. Chestnut DH, Owen CL, Bates JN, et al. Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology 1988; 68: 754–9

    Article  PubMed  CAS  Google Scholar 

  44. Cohen SE, Tan S, Albright GA, et al. Epidural fentanyl/bupivacaine mixtures for obstetric analgesia. Anesthesiology 1987; 67: 403–7

    Article  PubMed  CAS  Google Scholar 

  45. Phillips GH. Combined epidural sufentanil and bupivacaine for labor analgesia. Reg Anesth 1987; 12: 165–8

    Google Scholar 

  46. Russell R, Reynolds F. Epidural infusions for nulliparous women in labor. Anaesthesia 1993; 48: 856–61

    Article  PubMed  CAS  Google Scholar 

  47. Benlabed M, Dreizzen E, Ecoffey C, et al. Neonatal patterns of breathing after cesarean section with or without epidural fentanyl. Anesthesiology 1990; 73: 1110–3

    Article  PubMed  CAS  Google Scholar 

  48. Porter J, Bonello E, Reynolds F. Effect of epidural fentanyl on neonatal respiration. Anesthesiology 1998; 89: 79–85

    Article  PubMed  CAS  Google Scholar 

  49. Loftus JR, Hill H, Cohen SE. Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor. Anesthesiology 1995; 83: 300–8

    Article  PubMed  CAS  Google Scholar 

  50. Kick O, Vertommen JD, Van Aken H, et al. Sufentanil: maternal and neonatal plasma levels after epidural administration during labor and delivery [abstract]. Anesthesiology 1991; 75: A837

    Article  Google Scholar 

  51. Palot M, Visseaux H, Botmans C, et al. Placental transfer and neonatal distribution of fentanyl, alfentanil, and sufentanil after continuous epidural administration for labor [abstract]. Anesthesiology 1992; 77: A991

    Article  Google Scholar 

  52. Steinberg RB, Dunn S, Dixon D, et al. Comparison of sufentanil, bupivacaine, and their combination for epidural analgesia in obstetrics. Reg Anesth 1992; 17: 131–8

    PubMed  CAS  Google Scholar 

  53. Zakowski M, Schlesinger J, Dumbroff S, et al. In vitro human placental uptake and transfer of fentanyl [abstract]. Anesthesiology 1993; 79: A1006

    Google Scholar 

  54. Zakowski MI, Grant GJ, Turndorf H. Uptake and transfer of sufentanil in human placenta during in vitro perfusion [abstract]. Anesth Analg 1995; 80: S577

    Google Scholar 

  55. Gaylard DG, Carson RJ, Reynolds F. Effect of umbilical perfusate pH and controlled maternal hypotension on placental drug transfer in the rabbit. Anesth Analg 1990; 71: 42–8

    Article  PubMed  CAS  Google Scholar 

  56. Landau R, Schiffer E, Morales M, et al. The dose-sparing effect of clonidine added to ropivacaine for labor epidural analgesia. Anesth Analg 2002; 95: 728–34

    PubMed  CAS  Google Scholar 

  57. Mercier FJ, Dounnas M, Bouaziz H, et al. The effect of adding a minidose of clonidine to intrathecal sufentanil for labor analgesia. Anesthesiology 1998; 89: 594–601

    Article  PubMed  CAS  Google Scholar 

  58. Paech MJ, Banks S, Lyle G, et al. A randomized, double blind trial of subarachnoid bupivacaine and fentanyl with or without clonidine, for combined spinal/epidural analgesia during labor. Anesth Analg 2002; 95: 1396–401

    Article  PubMed  CAS  Google Scholar 

  59. Chiari A, Lorber C, Eisenach JC, et al. Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor. Anesthesiology 1999; 91: 388–96

    Article  PubMed  CAS  Google Scholar 

  60. D’Angelo R, Evan E, Dean LA, et al. Spinal clonidine prolongs labor analgesia from spinal sufentanil and bupivacaine. Anesth Analg 1999; 88: 573–6

    Article  PubMed  Google Scholar 

  61. Tsen LC, Thue B, Datta S, et al. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999; 91: 920–5

    Article  PubMed  CAS  Google Scholar 

  62. Nageotte MP, Larson D, Rumney PJ, et al. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med 1997; 337: 1715–9

    Article  PubMed  CAS  Google Scholar 

  63. Smedvig JP, Soreide E, Gjessing L. Ropivacaine 1 mg/ml, plus fentanyl 2 microg/ml for epidural analgesia during labour: is mode of administration important? Acta Anaesthesiol Scand 2001; 45: 595–9

    Article  PubMed  CAS  Google Scholar 

  64. Fernando R, Bonello E, Gill P, et al. Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labour. Anaesthesia 1997; 52: 517–24

    Article  PubMed  CAS  Google Scholar 

  65. Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia [letter]? Anesthesiology 1994; 81: 108

    Article  Google Scholar 

  66. Eberle RL, Norris MC, Eberle AM, et al. The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia. Am J Obstet Gynecol 1998; 179: 150–5

    Article  PubMed  CAS  Google Scholar 

  67. Nielsen PE, Erickson JR, Abouleish EI, et al. Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance. Anesth Analg 1996; 83: 742–6

    PubMed  CAS  Google Scholar 

  68. Palmer CM, Maciulla JE, Cork RC, et al. The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia. Anesth Analg 1999; 88: 577–81

    PubMed  CAS  Google Scholar 

  69. Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology 1998; 89: 1336–44

    Article  PubMed  CAS  Google Scholar 

  70. Ramin SM, Gambling DR, Lucas MJ, et al. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995; 86: 783–9

    Article  PubMed  CAS  Google Scholar 

  71. Albright GA, Forster RM. Does combined spinal/epidural analgesia with intrathecal sufentanil increase the incidence of emergency cesarean section? Reg Anesth 1997; 22: 400–5

    Article  PubMed  CAS  Google Scholar 

  72. Ostman LP, Owen CL, Bates JN, et al. Oxygen saturation in patients the night prior to and the night after cesarean section during epidural morphine analgesia [abstract]. Anesthesiology 1988; 69: A691

    Article  Google Scholar 

  73. Norris MC, Fogel S, Holtmann B. Intrathecal sufentanil (5 vs 10 µg) for labor analgesia: efficacy and side effects. Reg Anesth Pain Med 1998; 23: 252–7

    PubMed  CAS  Google Scholar 

  74. Fuller JG, McMorland GH, Douglas MJ, et al. Epidural morphine for analgesia after cesarean section: a report of 4800 patients. Can J Anaesth 1990; 37: 636–40

    Article  PubMed  CAS  Google Scholar 

  75. Hon EH, Reid BL, Heher FW. The electronic evaluation of fetal heart rate: II. Changes with maternal hypotension. Am J Obstet Gynecol 1960; 79: 209–15

    PubMed  CAS  Google Scholar 

  76. Philipson EH, Kuhnert BR, Pimentel R, et al. Transient maternal hypotension following epidural anesthesia. Anesth Analg 1989; 69: 604–7

    Article  PubMed  CAS  Google Scholar 

  77. Preston R, Crosby ET, Kotarba D, et al. Maternal positioning affects fetal heart rate changes after epidural analgesia for labour. Can J Anaesth 1993; 40: 1136–41

    Article  PubMed  CAS  Google Scholar 

  78. Aldrich CJ, D’Antona D, Spencer JA, et al. The effect of maternal posture on fetal cerebral oxygenation during labour. Br J Obstet Gynaecol 1995; 102: 14–9

    Article  PubMed  CAS  Google Scholar 

  79. Al-Mufti R, Morey R, Shennan A, et al. Blood pressure and fetal heart rate changes with patient-controlled combined spinal-epidural analgesia while ambulating in labour. Br J Obstet Gynaecol 1997; 102: 192–7

    Google Scholar 

  80. Umstad MP, Ross A, Rushford DD, et al. Epidural analgesia and fetal heart rate abnormalities. Aust N Z J Obstet Gynaecol 1993; 33: 269–72

    Article  PubMed  CAS  Google Scholar 

  81. Collins KM, Bevan DR, Beard RW. Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour. BMJ 1978; 25: 1460–1

    Article  Google Scholar 

  82. Fusi L, Steer P, Maresh M, et al. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet 1989; I: 1250–2

    Article  Google Scholar 

  83. Camann W, Hortvet L, Hughes N, et al. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth 1991; 67: 565–8

    Article  PubMed  CAS  Google Scholar 

  84. Herbst A, Wolner-Hanssen P, Ingaemarsson I. Maternal fever in term labour in relation to fetal tachycardia, cord artery acidaemia and neonatal infection. Br J Obstet Gynaecol 1997; 104: 363–6

    Article  PubMed  CAS  Google Scholar 

  85. Lieberman E, Cohen A, Lang J, et al. Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery. Am J Public Health 1999; 89: 506–10

    Article  PubMed  CAS  Google Scholar 

  86. Lieberman E, Lang J, Frigoletto FJ, et al. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 1997; 99: 415–9

    Article  PubMed  CAS  Google Scholar 

  87. Philip J, Alexander J, Sharma S, et al. Epidural analgesia during labor and maternal fever. Anesthesiology 1999; 90: 1271–5

    Article  PubMed  CAS  Google Scholar 

  88. Goodlin R, Chapin J. Determinants of maternal temperature during labor. Am J Obstet Gynecol 1982; 143: 97–101

    PubMed  CAS  Google Scholar 

  89. Panzer O, Ghazanfari N, Sessler D, et al. Shivering and shivering-like tremor during labor with and without epidural analgesia. Anesthesiology 1999; 90: 1609–16

    Article  PubMed  CAS  Google Scholar 

  90. Webb P, James F, Wheeler A. Shivering during epidural analgesia in women in labor. Anesthesiology 1981; 55: 706–7

    Article  PubMed  CAS  Google Scholar 

  91. Negishi C, Lenhardt R, Makoto O, et al. Opioids inhibit febrile responses in humans, whereas epidural analgesia does not: an explanation for hyperthermia during epidural analgesia. Anesthesiology 2001; 94: 218–22

    Article  PubMed  CAS  Google Scholar 

  92. Gross JB, Cohen AP, Lang JM, et al. Differences in systemic opioid use do not explain increased fever incidence in parturients receiving epidural analgesia. Anesthesiology 2002; 97: 157–61

    Article  PubMed  CAS  Google Scholar 

  93. Dashe J, Rogers B, McIntire D, et al. Epidural analgesia and intrapartum fever: placental findings. Obstet Gynecol 1999; 93: 341–4

    Article  PubMed  CAS  Google Scholar 

  94. Lteif AN, Schwenk II WF. Breast milk revisited. Mayo Clin Proc 1998; 73: 760–3

    Article  PubMed  CAS  Google Scholar 

  95. Villalpando S, Hamosh M. Early and late effects of breast-feeding: does breastfeeding really matter? Biol Neonate 1998; 74: 177–91

    Article  PubMed  CAS  Google Scholar 

  96. Walker M. Do labor medications affect breastfeeding? J Hum Lact 1997; 13: 131–7

    Article  PubMed  CAS  Google Scholar 

  97. Murray AD, Dolby RM, Nation RL, et al. Effects of epidural anesthesia on newborns and their mothers. Child Dev 1981; 52: 71–82

    Article  PubMed  CAS  Google Scholar 

  98. Halpern SH, Levine T, Wilson DB, et al. Effect of labor analgesia on breastfeeding success. Birth 1999; 26: 83–8

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors have provided no information on sources of funding or on conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Anesthesia, Città di Roma Hospital, Via Maidalchini 12, 00152, Roma, Italy

    Giorgio Capogna & Michela Camorcia

Authors
  1. Giorgio Capogna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michela Camorcia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giorgio Capogna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Capogna, G., Camorcia, M. Epidural Analgesia for Childbirth. Pediatr-Drugs 6, 375–386 (2004). https://doi.org/10.2165/00148581-200406060-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00148581-200406060-00005

Keywords

Search

Navigation