Analgesia in labour: induction and maintenance

Abstract 

Labour epidural analgesia underwent marked changes from the mid 1980s to the 1990s. The addition of opioids, such as fentanyl, to local anaesthetic reduced motor block and improved analgesia and maternal satisfaction. The introduction of new techniques such as combined spinal epidural analgesia and patient-controlled epidural analgesia further enhanced regional techniques. Dense motor block, historically associated with labour epidural analgesia, has now been reduced to a level where some mothers can choose to mobilize safely out of bed during their labour. In the past decade, research has focused on finding the ideal technique and combination of drugs to provide reliable analgesia with minimal motor block. No one technique has become universally popular, and the introduction of the new levo or s- enantiomer local anaesthetic has not had a major impact on labour analgesia practice. Currently, women can enjoy safe, reliable epidurals for labour analgesia with reduced or minimal motor blockade. The decisions are based on two decades of published research.

Keywords: combined spinal epidural, epidural, labour analgesia, patient-controlled epidural anaesthesia, test dose