the ability is still there. The patient will usually feel contractions. The side effects are
severe maternal hypotension due to vasodilation and decreased oxygen to the fetus as
a result of hypotension.
Figure 4-7. Saddle block.
Caudal or lumbal epidural.
(a) Caudal is an injection of anesthetic agent in the peridural space
through the sacral hiatus (see figure 4-8). Lumbar epidural is an injection of anesthetic
agent on top of the dura space through the 3rd and 4th or 5th lumbar space. These
anesthetics numb the abdominal and pelvic areas below the umbilicus to the midthigh.
The patient doesn't feel contractions or perineal stretching. The urge to push may be
blocked, although the ability is still present.
(b) The advantages of caudal or lumbal epidural are that they are a
good pain relief, the patient is alert and cooperative, and there is decreased danger of
The side effects include:
1 Hypotension secondary to peripheral vasodilation.
2 If dura infusion -- lower extremity sensory changes and loss of
the ability to move lower extremities.
3 If blood stream infusion -- ringing in the ears, lightheadedness,
circumoral (around mouth) tingling, numbness, metallic taste, and seizures.
4 Burning at the site of injection.