The trial of labor
analgesia in Japan dates back to the year 1929. After the foundation of the original Japan Society of
Obstetric Anesthesia and Perinatology in 1961, various labor
analgesia techniques were widely attempted. Some anesthetists relieved the
labor pain with
balanced anesthesia using intravenous (
diazepam and
pethidine during the 1st stage of labor, followed by
pentobarbital or
ketamine during the 2nd stage of labor) combined with inhalational
anesthetic (
methoxyflurane or
enflurane), while the others tried
regional anesthesia. In 1990's,
epidural analgesia with
bupivacaine became more popular as a standard method of labor
analgesia. Recently, the choice of
local anesthetic has changed to
ropivacaine or
levobupivacaine, and in most cases combined with an
opioid. Combined spinal-
epidural analgesia or patient-controlled
epidural analgesia has also been accepted in some hospitals, because these techniques may lessen the total consumption of
local anesthetics and also induce mothers' satisfaction. However, the ideal labor
analgesia technique has been still controversial. We, obstetric anesthesiologists, should grope for safer and more comfortable
anesthetics to the mother and fetus. In next 50 years, the standard method for labor
analgesia may change to no needle system with non-placental transfer
anesthetics.