Improved epidural analgesia in the parturient in the 30° tilt position

Purpose: To compare the incidence of incomplete analgesia when epidural local anesthetic is administered with the parturient supine in a 30 degrees leftward tilt or in the left lateral decubitus position. Methods: After placement of a multiorifice catheter 5 cm into the epidural space, 293 women in active labour were randomly positioned either to the left lateral decubitus position (lateral group) or supine with a 30 degrees leftward tilt (tilt group) and then received 13 mt bupivacaine 0.25%. The success of the epidural block was determined by asking the patient if she required additional medication 15 min later. The incidence of complications (fetal heart rate decelerations, hypotension, and ephedrine usage) was noted. Results: In the lateral group, 38% required additional medication compared with 24% in the tilt group (P = 0.006). There were no differences between groups in the incidence of maternal hypotension or fetal heart rate decelerations, but more women (10%) received ephedrine in the lateral than in the tilt group (4%), P = 0.035, Conclusions: Placing the parturient supine with a 30 degrees leftward tilt is associated with a greater success rate of labour epidural analgesia without an increase in complications than in women in the left lateral decubitus position. This advantage should be considered when positioning the parturient after epidural catheter placement.