Update on Non-neuraxial Labor Analgesia

Karol, Dana; Weiniger, Carolyn F.

doi:10.1007/s40140-021-00463-4

Cited by 10 publications

(5 citation statements)

References 39 publications

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“…With the rapid development of medical science, and the increasing demands of modern people on the pain relief and quality of life, labor analgesia has been paid more and more attention by mothers and medical workers [ 1 ]. At present, the main methods of labor analgesia include spinal analgesia, application of sedative drugs such as pethidine and diazepam, and some non-drug labor analgesia, such as water birth, etc., of which spinal analgesia accounts for more than half of the analgesia [ 2 ]. Spinal analgesia is now very mature and is the gold standard for labor analgesia in the world.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review

Lei

et al. 2022

PLoS ONE

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Background Remifentanil patient-controlled analgesia (rPCA) and epidural analgesia (EA) has been used for pain relief in labor. We aimed to evaluate the efficacy and safety of rPCA versus EA in labor, to provide evidence support for clinical analgesia and pain care. Methods We searched PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases for RCTs comparing rPCA and EA in labor until February 15, 2022. Two researchers independently screened literature and extracted data. RevMan 5.3 software was used for data analysis. Results A total of 10 RCTs involving 3086 parturients were enrolled, 1549 parturients received rPCA and 1537 received EA. Meta-analysis indicated that the incidence of intrapartum maternal fever within 1 hour of labor analgesia (OR = 0.43, 95%CI: 0.30~0.62), after 1 hour of labor analgesia (OR = 0.42, 95%CI: 0.20~0.90) in the rPCA was significantly less than that of EA (all P<0.05). The incidence of respiratory depression (OR = 3.56, 95%CI: 2.45~5.16, P<0.001) in the rPCA was significantly higher than that of EA. There were no significant differences in the incidence of Apgar scores<7 at 5 minutes (OR = 1.18, 95%CI: 0.71~1.96, P = 0.53), the patients’ satisfaction of pain relief during labor analgesia (SMD = 0.03, 95%CI: -0.40~0.46, P = 0.90) between rPCA and EA (all P>0.05). Conclusion rPCA can be an optional alternative to EA with similar pain relief and less risk of intrapartum maternal fever. However, rPCA was associated with increased risk of respiratory depression. Future studies with rigorous design and larger sample size are needed to provide more reliable evidences for clinical rPCA and EA use.

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Section: Introductionmentioning

confidence: 99%

The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review

Lei

et al. 2022

PLoS ONE

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“…Although neuraxial analgesia offers highly effective labor pain relief, its utilization in labor can be influenced by factors like availability, contraindications, and individual preferences [23]. Severe conditions like deep vein thrombosis, pulmonary embolism, mechanical heart valve, arrhythmia, severe scoliosis, or post-surgical spine instrumentation may preclude optimal and timely administration of neuraxial labor analgesia [24]. Other analgesic strategies are indicated when central neuraxial analgesia is contraindicated, technically infeasible, or if the patient's preference dictates.…”

Section: Discussionmentioning

confidence: 99%

Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries

Stopar Pintarič,

Pavlica,

Druškovič

et al. 2024

Biomol Biomed

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General anaesthesia is typically recommended for category 1 emergency caesarean delivery (CD). For categories 2-4 emergencies, either regional and general anaesthesia could be used. However, the factors influencing the choice of anaesthetic technique in these categories remain poorly understood. We analysed the association between the type of labour analgesia and subsequent anaesthetic techniques employed for intrapartum categories 2 and 3 CD. A prospective longitudinal cohort study was conducted at the University Medical Centre Ljubljana. A total of 300 women who underwent emergency CD between March and October 2021 were consecutively enrolled and categorised according to Lucas's classification of CD urgency. Parturients with category 1 and category 4 emergency CD were excluded from the analysis. Demographic, obstetric, and anaesthetic data were recorded. The techniques of anaesthesia (general, spinal, and epidural anaesthesia) employed for CD were analysed with respect to labour analgesia methods (remifentanil patient-controlled analgesia [remifentanil-PCA], epidural analgesia, and nitrous oxide). Of the participants, 124 (41.3%) had category 2, and 96 (32%) had category 3 emergency CD. Epidural analgesia was the most frequent analgesic option (43.8%), followed by remifentanil-PCA (20.7%) anditrous oxide (5.1%), while 30.4% of parturient women received no analgesia. All anaesthetic methods showed a significant relationship with analgesic modalities (P < 0.001). Remifentanil-PCA was associated with a higher incidence of general anaesthesia. Contraindication to epidural analgesia was the primary factor related to the transition from remifentanil-PCA to general anaesthesia. Most parturients who received epidural analgesia were successfully converted to epidural anaesthesia. Spinal anaesthesia was the most common technique in women using N2O and those without labour analgesia. General anaesthesia was associated with lower 5 min Apgar scores. The method of labour analgesia is associated with the anaesthesia technique employed for categories 2 and 3 CD. This finding may guide patient counselling and intrapartum anaesthetic planning. However, the analysis should be cautiously interpreted as the selection of anaesthesia is a complex decision influenced by several clinical considerations.

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“…Among non-neuraxial techniques, remifentanil intravenous patient-controlled analgesia (IV-PCA) provides effective labour analgesia but with potential side effects such as maternal hypoxia, respiratory or cardiac arrest, pruritus, nausea, and vomiting. [ 9 ] Datasets of the RemiPCA SAFE network database from 6 consecutive years show that maternal hypoxia was 24.7% with remifentanil along with a low neonatal oxygen supplementation rate at 5%. [ 10 ]…”

Section: Labour Analgesiamentioning

confidence: 99%

Recent advances in obstetric anaesthesia and critical care

Kurdi

Rajagopal

Sangineni

et al. 2023

Indian Journal of Anaesthesia

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Newer modalities in labour analgesia and anaesthesia for caesarean section including regional anaesthesia techniques and airway management are emerging constantly. Techniques such as point of care ultrasound, especially of the lungs and stomach and point of care tests of coagulation based on viscoelastometry are about to revolutionise perioperative obstetric care. This has improved the quality of care thereby ensuring good perioperative outcomes in the parturient with comorbidities. Critical care for obstetrics is an emerging field that requires a multidisciplinary approach with obstetricians, maternal-foetal medicine experts, intensivists, neonatologists, and anaesthesiologists working together with enhanced preparedness and uniform protocols. Newer techniques and concepts of understanding have thus been established in the traditional speciality of obstetric anaesthesia over the last decade. These have improved maternal safety and neonatal outcomes. This article touches upon some recent advances that have made a significant impact in the field of obstetric anaesthesia and critical care.

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Update on Non-neuraxial Labor Analgesia

Cited by 10 publications

References 39 publications

The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review

The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review

Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries

Recent advances in obstetric anaesthesia and critical care

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