Lumbar Epidural Analgesia for Labor and Vaginal Delivery

Abstract

Lumbar epidural analgesia has become the preferred method of pain relief for labor and delivery. Proper administration of epidural analgesia offers many advantages for both mother and fetus. With the availability of various local anesthetics, opioids, and infusion techniques, the analgesia can be tailored to the specific needs of the mother, fetus, and labor. Its effect on the progress of labor remains a controversial topic subject to ongoing investigation.

Effect of Availability of a Parturient-elective Regional Labor Pain Relief Service on the Mode of Delivery

“…The instability of the usage rate of an ondemand regional analgesia and the lack of familiarity with the method have been considered to influence results on the association between the pain relief service and operative delivery rates. 15,21 In this study, the similar results during the early and later postimplementation periods showed a stable effect of regional analgesia on the mode of delivery following the introduction of the service in this hospital. However, the decrease in the laceration rate in the later period among parturients using the analgesia service in comparison with that in the early postimplementation period suggests that the familiarity of the obstetric staff with the effects of the use of the pain relief service may minimize possible complications.…”

“…14 Other advantages of epidural and intrathecal analgesia for parturients, including easier vacuum application and less painful episiotomy repair, have been described. 15 A meta-analysis estimated a 10% increase in the cesarean birth rate for the indication of dystocia associated with epidural analgesia. 16 However, a negligible impact of regional analgesia initiated during early or late labor on the dystocia-related cesarean delivery rate has been reported in several other retrospective and prospective randomized studies.…”

“…Epidural analgesia makes vacuum extraction easier because of the dense epidural block and local muscle relaxation. 15 Therefore, the local lacerations may not have been related to the use of the pain relief service.…”

Parturition in Mammals: Animal Models, Pain and Distress

“…However, in monotocous species (like women), the complete newborn expulsion resembles the third stage. During this stage, uterine contractions remain, diminishing in amplitude but with the highest and least regular frequency [62]; this phase of labour is believed to be painless [86]. In the first stage, there are slight but constant uterine contractions; as the strength of the contractions increases, concomitantly with the distension, effort, and tear of the lower uterine segment and the cervix, it becomes strongest and induces visceral pain with afferent information travelling within the hypogastric and pelvic nerves [15].…”

“…The nociceptive stimuli are processed and transmitted at the dorsal horn of the spinal cord, via the spinothalamic region to the thalamus, brain stem, and cerebellum, where spatial and temporal analysis take place, and also to the hypothalamic and limbic systems [5]. The third stage of labour, the delivery, consists of the expulsion of the placenta and is not painful [86].…”