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Recent Advances in Labour Analgesia


Affiliations
1 Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
 

Pain of labour is said to be one of the most intense on the pain scale. Experience of labour varies among women, and even among different pregnancies in the same woman depending on various factors. Offering of analgesia to labouring women has become the standard of care across the globe. Since the earliest days when labour analgesia was initiated, multiple non pharmacological methods have been described. Different forms of exercises performed antenatally also have shown some benefit in labouring women. However pharmacological methods are more efficacious with higher chance of success compared to nonpharmacological methods. Systemic analgesics include administration of opioids and inhaled anaesthetics. Of special mention in recent times is the advantageous use of remifentanil for alleviating pain of labour. Inhaled anaesthetics are being less favoured due to their effects like amnesia. Neuraxial blockade remains to be the gold standard form of labour analgesia. Of the various methods, the most commonly followed forms include epidural analgesia and combined spinal epidural analgesia. Various new technological advances have been made to make administering analgesia via epidural easier, such as computer integrated patient controlled epidural analgesia and programmed intermittent epidural boluses which have been detailed in the review. Other newer technologies such as virtual reality are also described as newer forms of painless labour. Despite multiple options that are available, it must be borne in mind that each labouring woman and every birth is special. Hence, these options need to be tailored to suit every woman's needs during childbirth.

Keywords

Labour, Pain Pathways, Analgesia, Epidural.
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  • Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep; 1(3):277–99.

  • Capogna G, Camorcia M, Stirparo S. Expectant fathers’ experience during labor with or without epidural analgesia. Int J Obstet Anesth 2007; 16:110–15.

  • Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Does pain relief during delivery decrease the risk of postnatal depression? Acta Obstet Gynecol Scand 2004; 83:257–61.

  • Wong CA. Advances in labor analgesia. Int J Womens Health 2010; 1:139–54.

  • Carvalho B, Zheng M, Aiono-Le Tagaloa L. A prospective observational study evaluating the ability of prelabor psychological tests to predict labor pain, epidural analgesic consumption, and maternal satisfaction. Anesth Analg 2014; 119(3):632–40.

  • Jouppila R, Hollmen A. The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour. Acta Anaesth Scand 1976; 20:259–68.

  • Lederman RP, Lederman E, Work B, McCann DS. Anxiety and epinephrine in multiparous labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol 1985; 153:870–7.

  • Levinson G, Shnider SM, deLorimier AA, Steffenson JL. Effects of maternal hyperventilation on uterine blood flow and fetal oxygenation and acid-base status. Anesthesiology 1974; 40:340–7.

  • Shnider SM, Abboud T, Artal R, Henriksen EH, Stefani SJ, Levinson G. Maternal catecholamines decrease during labor after lumbar epidural analgesia. Am J Obstet Gynecol 1983; 147:13–5.

  • Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012 Mar; 14(3):CD009234.

  • Fogel ST, Shyken JM, Leighton BL, Mormol JS, Smeltzer J. Epidural labor analgesia and the incidence of Cesarean delivery for dystocia. Anesth Analg 1998; 87:119–23.

  • Gribble RK, Meier PR. Effect of epidural analgesia on the primary cesarean rate. Obstet Gynecol 1991; 78:231–4.

  • Johnson S, Rosenfield JA. The effect of epidural anesthesia on the length of labor. J Fam Pract 1995; 40:244–7.

  • Lyon DS, Knuckles G, Whitaker E, Salgado S. The effect of instituting an elective labor epidural program on the operative delivery rate. Obstet Gynecol 1997; 90:135–41.

  • Socol ML, Garcia PM, Peaceman AM, Dooley SL. Reducing caesarean births at a primarily private university hospital. Am J Obstet Gynecol 1993; 168:1748–58.

  • Segal S, Su M, Gilbert P. The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis. Am J Obstet Gynecol 2000; 183:974–8.

  • Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol 2006; 194:600–5.

  • Wong CA, Scavone BM, Peaceman AM et al. The risk of caesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005; 352:655–65.

  • American College of Obstetricians and Gynecologists Committee on Obsteteric Practice. Analgesia and cesarean delivery rates. ACOG Committee Opinion No. 339, June 2006. Obstet Gynecol 2006; 107:1487.

  • Comparative Obstetric Mobile Epidural Trial Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet 2001; 358:19–23

  • Babbar S, Parks-Savage A, Chauhan S. Yoga during pregnancy: a review. Am J Perinatol 2012; 29(06):459–64.

  • Makvandi S, Latifnejad Roudsari R, Sadeghi R, Karimi L. Effect of birth ball on labor pain relief: a systematic review and meta-analysis. J Obstet Gynaecol Res 2015; 41(11):1679–86.

  • Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev 2009. Art. No.: CD000111 .

  • Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev 2010; (9):CD007396.

  • Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S94–109.

  • Anderson D. A review of systemic opioids commonly used for labor pain relief. J Midwifery Womens Health 2011; 56(3):222–39.

  • Solek-Pastuszka J, Zagrodnik-Ulan E, Bohatyrewicz R, Celewicz Z. Remifentanil for labour pain relief. Anaesthesiol Intensive Ther 2015; 47(1):82–6.

  • Schnabel A, Hahn N, Broscheit J et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2012; 29:177−85.

  • Marwah R, Hassan S, Carvalho JC, Balki M. Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an obserwational study. Can J Anaesth 2012; 59:246−54.

  • Likis FE, Andrews JC, Collins MR, Lewis RM, Seroogy JJ, Starr SA et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg 2014; 118(1):153–67.

  • Koyyalamudi V, Sidhu G, Cornett EM, Nguyen V, Labrie-Brown C, Fox CJ, Kaye AD. New Labor Pain Treatment Options. Curr Pain Headache Rep 2016 Feb; 20(2):11.

  • Yeo ST, Holdcroft A, Yentis SM, Stewart A, Bassett P. Analgesia with sevoflurane in labour. II. Sevoflurane compared with entonox for labour analgesia. Br J Anaesth 2007; 98:110–5.

  • Pandya ST. Labour analgesia: Recent advances. Indian J Anaesth. 2010 Sep; 54(5):400–8.

  • Simmons SW, Taghizadeh N, Dennis AT, et al. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2012; 10:CD003401.

  • Heesen M, Van de Velde M, Klöhr S, et al. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia 2014; 69:64.

  • Perlas A, Chaparro LE, Chin KJ. Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med 2016; 41:251.

  • Van de Velde M, Berends N, Kumar A, Devroe S, Devlieger R, Vandermeersch E, et al. Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebocontrolled trial. Int J Obstet Anaesth 2009; 18:207–14.

  • Wallet F, Clement HJ, Bouret C, Lopez F, Broisin F, Pignal C et al. Effects of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial. Eur J Anaesthesiol 2010; 27:441–7.

  • Sng BL, Zhang Q, Leong WL, Ocampo C, Assam PN, Sia AT. Incidence and characteristics of breakthrough pain in parturients using computerintegrated patient-controlled epidural analgesia. J Clin Anesth 2015 Jun; 27(4):277–84.

  • Kaynar AM, Shankar KB. Epidural infusion: continuous or bolus? Anesth Analg 1999; 89:534

  • Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124:270.

  • Nelson KE, Rauch T, Terebuh V, D’Angelo R. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology. 2002 May; 96(5):1070–3.

  • Cappiello E, O’Rourke N, Segal S, Tsen LC. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia. Anesth Analg 2008; 107(5):1646–51

  • Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ et al. Virtual reality as an adjunctive nonpharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med 2011; 41(2):183–91


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  • Recent Advances in Labour Analgesia

Abstract Views: 333  |  PDF Views: 176

Authors

Rajashree Madabushi
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Anil Agarwal
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract


Pain of labour is said to be one of the most intense on the pain scale. Experience of labour varies among women, and even among different pregnancies in the same woman depending on various factors. Offering of analgesia to labouring women has become the standard of care across the globe. Since the earliest days when labour analgesia was initiated, multiple non pharmacological methods have been described. Different forms of exercises performed antenatally also have shown some benefit in labouring women. However pharmacological methods are more efficacious with higher chance of success compared to nonpharmacological methods. Systemic analgesics include administration of opioids and inhaled anaesthetics. Of special mention in recent times is the advantageous use of remifentanil for alleviating pain of labour. Inhaled anaesthetics are being less favoured due to their effects like amnesia. Neuraxial blockade remains to be the gold standard form of labour analgesia. Of the various methods, the most commonly followed forms include epidural analgesia and combined spinal epidural analgesia. Various new technological advances have been made to make administering analgesia via epidural easier, such as computer integrated patient controlled epidural analgesia and programmed intermittent epidural boluses which have been detailed in the review. Other newer technologies such as virtual reality are also described as newer forms of painless labour. Despite multiple options that are available, it must be borne in mind that each labouring woman and every birth is special. Hence, these options need to be tailored to suit every woman's needs during childbirth.

Keywords


Labour, Pain Pathways, Analgesia, Epidural.

References