麻豆传媒

LOS ANGELES, July 8-Just because an expectant father fainted and died of head injuries after watching his wife have an epidural doesn't mean the procedure itself is particularly dangerous.

What should have been a time of celebration ended in tragedy a year ago when Steven Passalaqua, 33, and his wife Jeannette, 32, were expecting the birth of their second child.

According to press reports of a lawsuit filed here last week against Kaiser Foundation Hospitals and the Southern California Permanente Medical Group, Passalaqua was asked by a hospital staff member to hold his wife while an employee inserted an epidural needle into her back.

The accounts of the suit indicate that at the sight of the needle, Passalaqua passed out, fell backward, hit his head on the aluminum cap molding at the base of the wall, and died two days later. His wife delivered a son.

The suit seeks unspecified damages. Kaiser has called the case "a tragic accident."

Epidural needles, which can average about five inches in length, can make many patients feel uneasy, but for physicians, they are critical in managing labor pain. However, despite clinicians' increasing use of epidural analgesia, the procedure's consequences have been repeatedly questioned.

In the past, epidural blocks were suspected to be associated with stalling labor and increasing the need for a Cesarean. But a study published in the March 2005 issue of the journal Best Practice & Research Clinical Anaesthsiology, University of Pennsylvania researchers reported that while "epidural analgesia does prolong labor…the clinical significance of this prolongation has not been shown."

The report also said, "The use of epidural analgesia does not increase the risk of cesarean section."

There has also been debate on precisely when during labor to administer the epidural.

Earlier this year, in the Feb. 17 issue of The New England Journal of Medicine, Northwestern researchers found Cesarean rates did not significantly differ among 750 nulliparous women who either received epidural analgesia during early labor (less than four centimeters dilation) or during later labor (4 cm dilation or more).

Three months prior to that study's release, researchers from Sunnybrook and Women's College Health Sciences Centre in Toronto reported in the November issue of Anesthesia and Analgesia that patient-controlled epidural analgesia did not result in an increased incidence of obstetrical intervention. Epidurals provided "superior analgesia and less maternal and neonatal sedation compared with patient-controlled intravenous opioid analgesia," the randomized, controlled trial found.

This study found that the second stage of labor lasted an average of 23 minutes longer among the epidural group. But the maternal mean pain and satisfaction scores in response to their pain relief treatment were higher in the epidural group compared with the intravenous opioid group (P <0.001 and P = 0.02, respectively). More neonates required active resuscitation in the intravenous opioid subjects than in the epidural group (52% versus 31%; P = 0.001), the Canadian team reported.

Local infection from the site of an epidural injection is a risk but, overall, epidurals are well tolerated by most patients. The American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists stand by the safety of epidural analgesia and say they support epidural pain relief "on demand."

"During any stage of labor is sufficient medical indication to provide it," ACOG said. "There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain that is amenable to safe intervention."

Related article:

• Epidural Analgesia Safe and Effective During Early Labor