The cutaneous sympathetic blockade associated with labour epidural analgesia

Iacona, G, Rolph, A, Manteigas, H, Strutton, P, Low, D ORCID: 0000-0001-7677-8634 and Mullington, C The cutaneous sympathetic blockade associated with labour epidural analgesia. British Journal of Anaesthesia. ISSN 0007-0912 (Accepted)

Text The cutaneous sympathetic blockade associated with labour epidural analgesia a during-after quasi-experimental study.pdf - Accepted Version Access Restricted Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (916kB)

Abstract

Background: The mechanism underlying epidural-related hyperthermia is unclear. One explanation is that blockade of cholinergic sympathetic nerves prevents active vasodilation and sweating. However, it is not known how labour epidural analgesia affects cutaneous sympathetic function. This physiological study assessed cholinergic and noradrenergic cutaneous sympathetic function in the upper and lower limbs. Hypothesis: labour epidural analgesia inhibits cholinergic and noradrenergic function in the lower limbs. Methods: 20 women with epidural analgesia had upper and lower limb cutaneous sympathetic skin responses assessed during labour (epidural) and after delivery (control). Responses were evoked with auditory stimuli (loud clicks) delivered through headphones. Sudomotor skin responses (cholinergic function) were recorded with Ag/AgCl electrodes on the hand and foot. Vasomotor skin responses (noradrenergic function) were recorded with laser doppler flowmetry on the finger and toe. Results: Median [range] sudomotor skin response amplitude was less on the epidural visit in both the hand (epidural 0.05[0.00-1.87]mV, control 0.69[0.02-3.73]mV; p=0.013) and the foot (epidural 0.00[0.00-0.92]mV, control 0.53 [0.05-2.79] mV; p<0.0001). Median [range] vasomotor skin response reduction rate was less on the epidural visit in the toe (epidural 6.3[0.0-41.8]%, control 18.2[0.0-53.3]%; p=0.0002), but did not differ between visits in the finger (epidural 7.9[0.0-29.9]%, control 5.0[0.0-29.8]%; p=0.24). Conclusions: Labour epidural analgesia can inhibit cholinergic sympathetic outflow to 90% of the body surface. Cholinergic sympathetic blockade could prevent women offloading the additional heat generated during labour, increasing the risk of hyperthermia. The distribution of cutaneous sympathetic blockade varied among individuals and thus cholinergic sympathetic blockade distribution is a potential risk factor for epidural-related hyperthermia.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; Anesthesiology; 3202 Clinical sciences
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Elsevier
Date of acceptance:	2 July 2025
Date Deposited:	24 Jul 2025 09:18
Last Modified:	24 Jul 2025 09:30
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26823

View Item