Ambulatory labor analgesia: what does an obstetrician need to know?

Abstract

A simple statement that describes the degree of the patient's satisfaction with the pain relief from her labor epidural analgesia has often assessed the quality of labor analgesia as perceived by the patient. Many laboring parturients, midwives, obstetricians and anesthesiologists are increasingly concerned by the limitations of traditional epidural labor analgesia. In general, women dislike the inability to void, the often-dense motor block, the feeling of numbness of the lower body, the total lack of the urge to bear down, and the complete perineal anesthesia. Continuous search for balanced labor analgesia that provides relief from pain, while preserving motor function, has led to the development of an ambulatory labor analgesia technique. This article assesses the validity of various strongly advocated opinions as to whether parturients benefit from ambulation in labor and also reviews the current trends in ambulatory labor analgesia.

A comparative study of the safety of 0.25% levobupivacaine and 0.25% racemic bupivacaine for paracervical block in the first stage of labor

“…In studies on animals, levobupivacaine, the S(–)‐enantiomer of racemic bupivacaine, has been found to be associated with lower risks of cardiovascular and central nervous system toxicity compared with racemic bupivacaine (14,15). The analgesic effect of levobupivacaine has been found to be equivalent to that of racemic bupivacaine in many clinical studies, including studies on epidural anesthesia for cesarean section and epidural and intrathecal labor analgesia (16–20). However, levobupivacaine has not been widely used in PCB.…”

Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section

“…Motor block was assessed using the modified Bromage score (1 = complete block, unable to move feet or knees; 6 = able to perform partial knee bend while standing). [ 17 18 19 20 ]…”

Designing a Postepidural Fall Risk Assessment Score for the Obstetric Patient

“…9 The hypotension is especially critical in a postpartum mother because the average estimated blood loss is 500 mL with a vaginal birth and 1000 mL with a cesarean section, which potentiates hypotension. 10,11 Research has suggested that multifaceted interventions involving patient assessments in various areas aid in the reduction of falls. 2 After an epidural, regional anesthesia that blocks nerve impulses from lower spinal segments needs to wear off for the patient to ambulate.…”