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Modern techniques to optimize neuraxial labor analgesia
Anesth Pain Med 2018;13(3):233-40
Published online July 31, 2018
© 2018 The Korean Society of Anesthesiologists.

Jalal A. Nanji and Brendan Carvalho
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
Correspondence to: Brendan Carvalho, MBBCh, FRCA, MDCH Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5640, Stanford, CA 94305, USA Tel: 1-650-724-2614 Fax: 1-650-725-8544 E-mail: carvalb@stanford.edu ORCID http://orcid.org/0000-0002-4919-4542
Received June 18, 2018; Revised June 21, 2018; Accepted June 29, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Key Words : Epidural analgesia, Neuraxial labor analgesia, Obstetrical analgesia, Pain management, Patient-controlled analgesia.


July 2018, 13 (3)
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