Labor analgesia

Abstract

We discuss recent advances in the administration of labor analgesia aimed at a more effective birthing experience for parturient women. Patient-controlled epidural analgesia (PCEA) is the most effective method of labor pain relief in medical practice. It also provides more consistent and predictable labor analgesia. When a parturient women has a contraindication to epidural analgesia, systemic analgesia techniques are provided as a guide to effective analgesia. PCEA of "low-dose" or "light mixtures" of local anesthetics and lipophilic opioids has allowed anesthesiologists to provide reasonable pain relief for most parturient women while decreasing the total dose of local anesthetics and opioids, thus minimizing the side effects of each agent. Fentanyl analgesia utilizing patient-controlled intravenous analgesia (PCIA), may provide effective self-titrated pain relief, although they are not as effective as the epidural method. Recently, remifentanil was suggested as the opioid of choice for labor analgesia. Potential advantages of remifentanil include better titration of analgesia and neonatal outcome. However, all systemic opioids rapidly cross the placenta. These drugs may cause neonatal respiratory and neurobehavioral depression. In order to reduce the incidence of breakthrough pain, more research on computer-integrated patient-controlled analgesia technology may be necessary. The study of a new local anesthetic drug that has less motor blockade and cardiotoxicity than ropivacaine is desirable, while PCEA is the most effective form of labor analgesia currently available. If epidural analgesia is contraindicated, PCI remifentanil bolus alone may be a suitable systemic analgesia for labor pain.