SummarySeveral strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is rapidly evolving, this review is an update, from a clinical point of view, of developments over the last 5-7 years. We discuss advantages and controversies related to combined spinal-epidural analgesia, patient controlled epidural analgesia and the integration of computer systems into analgesic modalities. We also review the recent literature on future clinical and research perspectives including ultrasound guided neuraxial block placement, epidural adjuvants and pharmacogenetics. We finally look at the latest work with regards to epidural analgesia and breastfeeding. Several strategies and alternative therapies have been used to provide analgesia for one of women's most painful experiences in life, labour pain. These include non-pharmacological approaches such as hypnosis, acupuncture, hydrotherapy and transcutaneous electrical nerve stimulation as well as the administration of nitrous oxide and low-dose sevoflurane and parenteral opioids. Although some of these therapies provide satisfactory pain relief from the mothers' point of view [1,2], there is evidence that neuraxial local anaesthetics and opioids yield superior and more reliable analgesia than these aforementioned methods [3,4].Although invasive, neuraxial labour analgesia is considered safe practice. Over the last decade, several improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. These developments include the introduction of combined spinal-epidural (CSE) analgesia, 'mobile epidurals', patient controlled epidural analgesia (PCEA), computer assisted injection of epidural solutions and ultrasound guided neuraxial techniques. Some of these advances have already been introduced into clinical practice while ongoing research is stimulated by the exciting clinical perspectives brought forward by other developments. This review focuses on the recent advances in neuraxial labour analgesia and on the relevant scientific literature published in the last 5 years. We performed a MEDLINE-based search of all the literature published from January 2005, using the following keywords: labour analgesia; epidural; spinal; combined spinal-epidural; pregnancy; obstetric; neostigmine; clonidine; pharmacogenetics; and breastfeeding. We focussed our research on prospective, randomised controlled trials as well as meta-analysis and further completed our review by including retrospective observational trials and case reports where relevant. For clarity of discussion and when considered necessary, we also included literature from earlier years. Initiating neuraxial analgesiaUltrasound guided neuraxial techniques Ultrasound i...

There is a need for safe, effective, and easy-to-administer systemic analgesia that ideally has rapid onset and offset, matches the time course of uterine contractions, and does not compromise the fetus. Although neuraxial blockade is the "gold standard" for labor analgesia, systemic analgesia is useful in those cases in which neuraxial analgesia is contraindicated, refused or simply not needed by the parturient, or when skilled anesthesia providers are not available. Because of its unique pharmacologic properties, remifentanil has been investigated, and is used clinically, to provide IV labor analgesia. In this focused review, we summarize the efficacy of remifentanil as a labor analgesic and review the current literature regarding its dose, mode of delivery, safety for the mother and fetus/neonate, as well as the scope for future research.

No abstract

No abstract