Updates In Regional Analgesia For Painless Labour

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 labour arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labour arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum.

Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labour. Over the last several decades neuraxial labour analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia.

The introduction of the combined spinal epidural technique for labour has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labour. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery.

New adjuvant drugs that improve the effectiveness of neuraxial labour analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labour analgesia practice.

Keywords: analgesia, epidural, spinal, local anesthesia, combined spinal epidural, labour