Patients will be randomly assigned to nitrogen or nitrous oxide intraoperatively. We anticipate that these data will show that replacing nitrous oxide with nitrogen reduces the incidence of wound infection and decreases the duration of hospitalization. Confirming our hypothesis would allow clinicians to make a minor modification in anesthetic practice that might reduce the incidence of a serious and costly complication. Meperidine spurs cervical collagenolysis and increases uterine contractility while bupivacaine does not. In a pilot study, women receiving initial lumbar sympathetic nerve block rather than epidural analgesia had faster labors and a trend toward fewer cesarean deliveries.
Epidural analgesia has a subtle tocolytic effect that is significant over an entire labor.
As a result, some prominent obstetricians suggest restricting epidural access. Anesthesiologists must acknowledge, understand and correct this tocolysis in order to provide excellent analgesia without impeding labor progress. All rights reserved.