Updates in Regional Anasthesia and Analgesia for Painless Labour
Abdalla Mohamed Mohamed Kamel Abdelhalim;
Abstract
The delivery of the infant into the arms of a conscious and pain-free mother is one of the most exciting and rewarding moments in medicine.
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive program of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, introduction of newer local anesthetics and adjuvants like ropivacaine, levobupivacaine, clonidine and neostigmine.
Labour pain is characterized by regular, painful uterine contractions that increase in frequency and intensity and are associated with progressive cervical effacement and dilatation.
In 1847, The Scottish obstetrician James Simpson administered ether to a woman during labour to treat the pain of childbirth; he was impressed with the degree of analgesia associated with the use of the drug
Regional techniques present the most flexible, effective, and least depressant options when compared with parenteral and inhalation techniques. Regional analgesia does not produce drug-induced depression in the mother or fetus. The most commonly performed regional techniques for labour are epidural, spinal, and combined spinal-epidural blocks. Less frequently, lumbar sympathetic blocks are performed
Epidurals are the most effective and consistently reliable way of relieving childbirth pain. An epidural will provide conduction anesthesia of the spinal nerves and the spinal cord (neuraxial block). The aim is to provide analgesia by blocking the A-delta and C fibers of the spinal segments involved in the transmission of labour pain. However, because spinal nerves transmit motor, autonomic and other sensory impulses, they will also be blocked if a large enough dose of local anesthetic is applied to them.
Ultrasound imaging of the lumbar spine can aid identification of necessary landmarks for epidural placement and estimate the depth of the epidural space in the pregnant patient. It may be especially beneficial in the obese parturient or in patients known to have previous difficult epidural placement.
Epidural administration of opioids alone provides analgesia for early labour but is inadequate for the later stages of labour. However, the combination of local anesthetic and opioid is synergistic. This is clearly advantageous, allowing improved quality of analgesia, reduced consumption of local anesthetic, reduced motor block and reduction in opioid side effects.
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive program of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, introduction of newer local anesthetics and adjuvants like ropivacaine, levobupivacaine, clonidine and neostigmine.
Labour pain is characterized by regular, painful uterine contractions that increase in frequency and intensity and are associated with progressive cervical effacement and dilatation.
In 1847, The Scottish obstetrician James Simpson administered ether to a woman during labour to treat the pain of childbirth; he was impressed with the degree of analgesia associated with the use of the drug
Regional techniques present the most flexible, effective, and least depressant options when compared with parenteral and inhalation techniques. Regional analgesia does not produce drug-induced depression in the mother or fetus. The most commonly performed regional techniques for labour are epidural, spinal, and combined spinal-epidural blocks. Less frequently, lumbar sympathetic blocks are performed
Epidurals are the most effective and consistently reliable way of relieving childbirth pain. An epidural will provide conduction anesthesia of the spinal nerves and the spinal cord (neuraxial block). The aim is to provide analgesia by blocking the A-delta and C fibers of the spinal segments involved in the transmission of labour pain. However, because spinal nerves transmit motor, autonomic and other sensory impulses, they will also be blocked if a large enough dose of local anesthetic is applied to them.
Ultrasound imaging of the lumbar spine can aid identification of necessary landmarks for epidural placement and estimate the depth of the epidural space in the pregnant patient. It may be especially beneficial in the obese parturient or in patients known to have previous difficult epidural placement.
Epidural administration of opioids alone provides analgesia for early labour but is inadequate for the later stages of labour. However, the combination of local anesthetic and opioid is synergistic. This is clearly advantageous, allowing improved quality of analgesia, reduced consumption of local anesthetic, reduced motor block and reduction in opioid side effects.
Other data
| Title | Updates in Regional Anasthesia and Analgesia for Painless Labour | Other Titles | الجديد في التخدير والتسكين الجزئي لحالات الولادة بدون الم | Authors | Abdalla Mohamed Mohamed Kamel Abdelhalim | Issue Date | 2015 |
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