British journal of anaesthesia
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The results of 324 Caesarean sections conducted under lumbar extradural block are discussed. In addition to pre-loading with fluid i.v. and the avoidance of aorto-caval compression, more recent modifications have been to administer bupivacaine in incremental doses, to be less concerned with the size of the total dose, and to provide the mother with supplementary oxygen until delivery. ⋯ The technique has many advantages for both mother and infant and with a good obstetric service, few disadvantages. Prolongation of the interval between incision of the myometrium and delivery appears to be less detrimental to the infant than is the case when general anaesthesia is used.
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The 119 patients who had undergone previous Caesarean section lumbar extradural block was administered to 77 (65%); the other 42 (35%) received analgesia with ketobemidone 0.8-1.0 ml i.m. or nitrous oxide in oxygen intermittently, or both. Controlled i.v. infusion of oxytocin for induction or acceleration of labour was given to 77% in the extradural group and to 40% in the other group. In both groups 88% were delivered per vaginam. In two patients the uterine scar ruptured; both had received oxytocin during extradural block.