Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Tulp, Maartje J; Paech, Michael J.

doi:10.2217/pmt.13.63

Cited by 10 publications

(5 citation statements)

References 107 publications

(133 reference statements)

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“…Since labor is associated with severe pain in most women, pain control is very important to improve patient satisfaction [ 31 , 32 ]. Currently, epidural analgesia is considered the gold standard in labor analgesia, providing the most effective pain relief during childbirth [ 33 , 34 ]. On the other hand, many women with healthy pregnancies want to minimize medical interventions and seek nonpharmacological ways to cope with labor pain.…”

Section: Discussionmentioning

confidence: 99%

Immersive virtual reality on childbirth experience for women: a randomized controlled trial

Carus

Albayrak

Bildirici

et al. 2022

BMC Pregnancy Childbirth

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Objective To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women. Methods This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory. Results We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 ± 12.9 out of a maximum of 100. Twenty out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 ± 1.2 compared to 2.0 ± 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.103 and p = 0.13, respectively). Conclusion Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants’ pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations. Trial Registration ClinicalTrials.gov: NCT05032456

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Section: Discussionmentioning

confidence: 99%

Immersive virtual reality on childbirth experience for women: a randomized controlled trial

Carus

Albayrak

Bildirici

et al. 2022

BMC Pregnancy Childbirth

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“…In 1/10 cases, manipulation of the catheter, such as retraction of the catheter for centimetres, is needed. Also, in 1/20 cases there is a need to reset the catheter 6 .…”

Section: Initiation Of Epidural Analgesia For Labourmentioning

confidence: 99%

Combined spinal-epidural analgesia for labour pain relief: a narrative review

Varvarousi,

Samartzi,

Valsamidis

2024

Acta Anaest Belg

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Ensuring analgesia during labour is particularly important and often demanding. The goal of neuraxial labour pain management is to ensure high-quality analgesia, covering sensory loss from T10-S4 dermatomes and minimize motor blockade. Epidural techniques provide relief to the parturients and, with the administration of appropriate doses, allowed for mobilization and unimpeded extrusion of the fetus. However, there are various complications associated with the method. We are now faced with increased rates of epidural failure in the management of labour pain. Often, the block is inadequate or unilateral and a repositioning or even replacement of the catheter is required. Therefore, it seems necessary to develop techniques aimed at reducing the failure rates of epidural analgesia. The initiation of labour with combined spinal epidural analgesia presents multiple potential benefits. It can be used in parturients requiring stronger pain relief, has a faster onset of action, better drug diffusion and achieves better sacral block. In addition, it is possible to confirm the position of the epidural space through the spinal pencil point needle (needle-through-needle technique), resulting in lower rates of epidural failure and postdural puncture headache. By administering an opioid intrathecally, minimal sympathetic block is achieved. Therefore, under certain circumstances combined spinal epidural analgesia could be superior to epidural analgesia. Further studies are needed to search for the ideal analgesia technique for the relief of parturient pain during labour.

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“…However, it has shown a limited impact on maternal pain scores and its analgesic effects are not consistently reliable. Moreover, it is frequently accompanied by adverse reactions such as nausea and vomiting [ 6 ]. However, remifentanil, as an ultra-short-acting opioid, can deliver satisfactory analgesic effects only when used for patient-controlled intravenous analgesia during labor [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of opioid and non-opioid analgesics in labor pain management: A network meta-analysis

Chen,

Yuan

2024

PLoS ONE

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Background Effective labor pain management is crucial for parturient well-being, as it can improve the delivery experience of pregnant women and reduce anxiety and tension. This systematic review and network meta-analysis compared the efficacy and safety of various analgesics, classified by drug category and individual treatment methods, for labor pain control. Methods A comprehensive literature search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of Science databases. All searches commenced from the database’s inception to the date of the literature search (May 31, 2023). The Cochrane Risk of Bias 2 tool assessed study bias risk. Network meta-analyses using a random-effects model and odds ratios (ORs) with 95% confidence intervals (CIs) were performed. Results Fifteen randomized controlled trials evaluating analgesic interventions in ASA I or II parturients were included. Combination therapies (OR: 5.81; 95% CI, 3.76–7.84; probability: 60%) and non-opioid analgesics (OR: 5.61; 95% CI, 2.91–8.30; probability: 39.2%) were superior to placebo for labor pain relief. Specifically, dexmedetomidine/ropivacaine/sufentanil (OR: 7.32; 95% CI, 2.73–11.89; probability: 40.6%) and dexmedetomidine/ropivacaine (OR: 6.50; 95% CI, 2.51–10.33; probability: 11.9%) combinations, bupivacaine/fentanyl and ropivacaine/sufentanil combinations, and remifentanil monotherapy showed improved analgesic efficacy versus placebo. Dexmedetomidine/ropivacaine reduced parturient nausea and vomiting versus alternatives. Conclusion Non-opioids, opioids and combinations thereof effectively relieved labor pain. In addition, dexmedetomidine/ropivacaine combination demonstrated analgesic efficacy and lower nausea and vomiting incidence.

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Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Cited by 10 publications

References 107 publications

Immersive virtual reality on childbirth experience for women: a randomized controlled trial

Immersive virtual reality on childbirth experience for women: a randomized controlled trial

Combined spinal-epidural analgesia for labour pain relief: a narrative review

Comparative efficacy of opioid and non-opioid analgesics in labor pain management: A network meta-analysis

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