Modern techniques to optimize neuraxial labor analgesia.
10.17085/apm.2018.13.3.233
- Author:
Jalal A NANJI
1
;
Brendan CARVALHO
Author Information
1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. carvalb@stanford.edu
- Publication Type:Review
- Keywords:
Epidural analgesia;
Neuraxial labor analgesia;
Obstetrical analgesia;
Pain management;
Patient-controlled analgesia
- MeSH:
Analgesia*;
Analgesia, Epidural;
Analgesia, Obstetrical;
Analgesia, Patient-Controlled;
Analgesics, Opioid;
Anesthetics, Local;
Humans;
Methods;
Pain Management;
Punctures;
Ultrasonography
- From:Anesthesia and Pain Medicine
2018;13(3):233-240
- CountryRepublic of Korea
- Language:English
-
Abstract:
Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patient-controlled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.
