Advances in labor analgesia

Abstract

The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

Attitude of obstetricians regarding labour analgesia and limitations in practising it

“…4 Relieving or reducing labour pain not only puts the women out of her misery, it also ameliorates various systemic adverse effects of pain and improves labour outcome. 5 In our study majority of the participants used parenteral NSAIDs or opioid (tramadol hydrochloride) for pain relief in labour. While tramadol does not induce respiratory distress in the new born unlike other opioids, it usually causes nausea when used.…”

Labour epidural analgesia audit in a teaching hospital in a developing country

“…1,2 However, it is uncertain whether data regarding labour epidural analgesia from the developed world [1][2][3][4] can be extrapolated to countries with limited resources.…”

A Prospective Comparative Study of Combined Spinal Epidural Labour Analgesia With Intrathecal Fentanyl 25 MCG Along With Two Doses of Epidural Bupivacaine With Epidural Fentanyl 2 McG/Ml

“…Providing effective and safe analgesia during labour was always a challenge and with the development in the field of pain management reflect a shift in obstetric anaesthesia from pain relief to overall quality of anaesthesia. 1 James Young Simpson first given the concept of "etherisation of labour" and administrated either to a women with deformed pelvis during childbirth, later John Snow administrated chloroform to Queen Victoria during the birth of her 8 th child, now we are in the era of neuraxial labour analgesia. 2,3 Various methods are available for labour analgesia, which includes pharmacological and non-pharmacological, but the neuraxial analgesia is considered as most effective method for labour pain relief with the development in the field of neuraxial analgesia, the techniques have become more refined and various newer and adjuvant drugs are used.…”