Analgesia in labour: induction and maintenance

Collis, Rachel E.; Davis, Huw

doi:10.1016/j.mpaic.2010.04.002

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Volume 11, Issue 7 , Pages 266-269, July 2010

Analgesia in labour: induction and maintenance

Rachel E Collis FRCA is Consultant Anaesthetist with a special interest in obstetric anaesthesia and analgesia at the University Hospital of Wales, Cardiff. She qualified from St Bartholomew’s Hospital, London, and trained in London. She now specializes in the assessment and management of the high-risk pregnant woman. Conflicts of interest: none declared

Huw Davis BSc FRCA is an Anaesthetics Registrar currently undertaking advanced training in obstetric anaesthesia at the University Hospital of Wales Cardiff. He qualified from University College London Medical School. Conflicts of interest: none declared

Abstract

Labour epidural analgesia underwent marked changes from the mid-1980s. The addition of opioids, such as fentanyl, to local anaesthetics reduced motor block as well as improving analgesia and maternal satisfaction. The introduction of new techniques such as combined spinal epidural analgesia and patient-controlled epidural analgesia has further enhanced regional techniques. Dense motor block, historically associated with labour epidural analgesia, has now been reduced to a level where some mothers can mobilize safely out of bed during their labour. Research continues to focus 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 anaesthetics 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.

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