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pearl
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Harrington rods are not a contraindication to epidural analgesia but do increase insertion difficulty, technique failure and complications, particularly dural puncture and subdural placement.
Ho AM, Ngan WD, Chung DC. Should laboring parturients with Harrington rods receive lumbar epidural analgesia? Int J Gynaecol Obstet. 1999 Oct 1;67(1):41-3.
  Daniel Jolley
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A case report and brief literature review examining the efficacy and complications of labor epidural analgesia in patients with Harrington rods after scoliosis surgery.
Ho, Ngan Kee & Chung reviewed 52 reported cases in the literature showing:
• Successful catheter insertion on first attempt in 47%
• Satisfactory and uncomplicated analgesia in 55%.
• Dural puncture in 4%.
• Subdural catheterization in 4%.
Lowest success rates, highest repeated-attempts and highest complication rates (DP 8%, failure 8%, poor analgesia 55%) occurred in those with a spinal surgery scar extending below the epidural insertion point.
Ho AM, Ngan WD, Chung DC. Should laboring parturients with Harrington rods receive lumbar epidural analgesia? Int J Gynaecol Obstet. 1999 Oct 1;67(1):41-3.
  Daniel Jolley
summary
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Collection: Interesting obstetric epidural articles
Articles of interest relevant to labor epidural analgesia, both specifically focusing on obstetric epidurals and more peripherally relevant to obstetric labor analgesia.
  Daniel Jolley
summary
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An interesting narrative focusing on John Snow's successful introduction of anesthesia, particularly chloroform, to obstetric practice in the 19th century.
The paper begins with a brief exploration of why James Young Simpson, arguably the first pioneer of obstetric anesthesia, failed to popularize this new technology when shortly thereafter Snow succeeded.
Caton D. John Snow's practice of obstetric anesthesia. Anesthesiology. 2000 Jan 1;92(1):247-52.
  Daniel Jolley
summary
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Collection: The History of Anesthesia
Papers focusing on the history of anesthesia – both modern articles and the original historical, landmark articles themselves.
  Daniel Jolley
pearl
1
Neuraxial analgesia early in labor does not increase the risk of cesarean delivery or increase the duration of labor compared with analgesia later in labor.
Wong CA, Scavone BM, Peaceman AM et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N. Engl. J. Med. 2005 Feb 17;352(7):655-65.
  Daniel Jolley
summary
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This follow-up paper to the original COMET study describes in detail the high and low-dose epidural techniques and the subsequent anesthetic characteristics.
The low-dose techniques used infusions of 0.1% bupivacaine with 2 mcg/mL fentanyl, compared with 10mL boluses of 0.25% bupivacaine. Maternal analgesia experience was similar between the groups, all the CSE group experienced better analgesia in the first hour.
Wilson MJ, Cooper G, MacArthur C et al. Randomized controlled trial comparing traditional with two "mobile" epidural techniques: anesthetic and analgesic efficacy. Anesthesiology. 2002 Dec 1;97(6):1567-75.
  Daniel Jolley
summary
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The COMET trial was a landmark study demonstrating the benefit on mode of delivery of using either a low-concentration (0.1% bupivacaine + 2mcg/mL fentanyl) epidural infusion or a combined spinal-epidural technique, over a traditional high-dose (10mL boluses of 0.25% bupivacaine) epidural.
Vaginal delivery rate was significantly higher in the low-dose (OR 1.38) and CSE (OR 1.39) groups than in the traditional high-dose group.
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 Jul 7;358(9275):19-23.
  Daniel Jolley
pearl
1
Low-concentration bupivacaine epidurals for labor analgesia result in a lower-incidence of instrumental delivery than 'traditional' high-dose bupivacaine epidurals.
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 Jul 7;358(9275):19-23.
  Daniel Jolley
summary
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Collection: Landmark obstetric anesthesia papers
A collection of landmark research articles relevant to obstetric anesthesia. Some, such as Hawkins' audits of U.S. maternal deaths, are significant because of their historical impact. Others hold direct clinical relevance for practice today.
  Daniel Jolley