There are many effective analgesic techniques available for women in labor and delivery. But the specific analgesic technique selected depends on the patients' medical status, the progress of labor, and facility resources as well as patients' preference. Of course, it is best if all pain management options are discussed ahead of time with one's health care provider during prenatal visits and a preliminary plan of action is developed at this time. The following will discuss the differences and indications for several regional techniques including epidural, spinal, and CSE anesthesia.
             Sicard and Cathelin in Paris first used caudal epidural anesthesia in 1901 yet; it was not used for painful labor until 1909 by von Stockel of Marburg. Unfortunately, this anesthesia was incomplete and short-acting. Fidel Pages of Spain then developed lumbar epidural and later a technique for continuous caudal analgesia with repeated injections through a catheter was introduced by Hingson & Edwards in 1942. Continuous lumbar epidural analgesia was developed by Hingson in 1946, but its use on a large scale in obstetrical practice did not occur until the late 1960s. Traditional epidurals consist of a catheter introduced into the epidural space at the L4-5 interspace between the ligumentum flavum and dura matter, and through this catheter, drugs may be administered. Identification of the epidural space is achieved by the loss of resistance or indrawing of the hanging drop of fluid and is followed by performing a test dose of 2-5cc of 2% lidocaine to ensure spinal injection has not occurred. The onset of analgesia is not immediate, but once effective the catheter allows prolongation of the block as required. Usual drugs used include 1-1.5% lidocaine and 0.25% bupivicaine they work by blocking conduction in nerves by impairing the propagation of the sodium channels action potentials. Potential complications of epidural anesthesia include headache se...