The "walking epidural" first appeared in the early 1990s. In some ways, it tested our widely held beliefs about how to provide effective and safe labour epidural analgesia and responded to women's requests to have effective labour analgesia without being confined to bed. In the first versions of the walking epidural, the combined spinal-epidural (CSE) technique was used. It provided initial analgesia with intrathecal narcotic, which was followed by a more standard continuous epidural infusion.This novel technique challenged our assumptions about the amount of neuraxial medication needed to initiate and maintain labour analgesia. Many labour analgesia studies ensued that resulted in significant changes to both the technique and the dosing strategies, and they led to a deeper understanding of the way in which local anesthetics and opioids work alone and synergistically in the neuraxium. Critical assessment of ambulation in labour with an epidural in situ has provided enormous benefit to women in labour, has changed how anesthesiologists provide labour epidural analgesia, and has added to the body of literature to convince our skeptical colleagues in obstetrics that epidurals don't necessarily mean an operative delivery. The end result of this scientific activity is patient-controlled labour epidural analgesia with low-dose solutions-there are so many benefits in that simple phrase. So, why has the enthusiasm for walking epidurals faded?
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