Epidural analgesia has become the most popular method for
labor pain relief.
Analgesia in Labor: Yes or No?
Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables.
Pain and anxiety lead to
adrenergic hyperactivity,
hyperventilation,
hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so
pain relief is recommended and even indicated in cases of maternal comorbidity.
Analgesia in Labor: Method of Choice. The quality of
epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation.
Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar
lordosis, soft tissue
edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural
puncture should be performed by medial approach, at L2-3 or L3-4 level by loss of resistance technique between contractions.
Epidural Analgesia in Labor: What With?
Local anesthetics,
bupivacaine,
levobupivacaine,
ropivacaine, are used and they can be combined with small doses of
opioids (
fentanyl or sufentanyl).
Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal--
epidural analgesia.
Epidural Analgesia in Labor: Controversies. The most important controversy is the influence ofepidural
analgesia on operative or instrumental delivery rate. Low concentrations of
local anesthetic in combination with small doses of
opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate.
CONCLUSION: