Labor anesthesia - the current state of knowledge

Abstract

Labor anesthesia has a long history from the era of ether and chloroform in the mid-nineteenth century to the present day - methods of a comprehensive approach to the treatment of labor pain using evidence-based medicine (EBM). The latest techniques of regional analgesia include low-dose epidural analgesia to allow patients to walk and patient-controlled infusion of anesthetic into the OA space, advances in pharmacotherapy have allowed the use of remifentanil for patient-controlled intravenous analgesia (PCA), new local anesthetics and adjuvants for analgesia have emerged epidural such as Ropivacaine, Levobupivacaine, Sufentanil, Clonidine, Neostigmine. The use of nitrous oxide in a mixture with oxygen and inhaled anesthetics in the form of personal vaporizers with methoxyflurane (Penthrox) seems to be a promising method of relieving labor pains. Technological advances, such as the use of ultrasound to locate the epidural space in difficult cases, minimize unsuccessful epidural anesthesia. The introduction of novel drug delivery methods such as Patient Controlled Epidural (PCEA) pumps improved the overall rate of maternal satisfaction and made it possible to tailor an appropriate analgesic regimen for each woman giving birth. Recent randomized trials and Cochrane analyzes have shown that the association of epidural anesthesia with increased rates of cesarean delivery and long-term back pain remains a myth. Studies have also shown that newer, low-dose analgesia regimens do not have a statistically significant effect on the duration of labor and the onset of breastfeeding, and that they reduce the percentage of instrumental births, thus improving maternal and fetal safety.