Labour analgesia: update and literature review

Abstract

Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it leads to higher maternal satisfaction and good maternal and fetal safety profiles. We examine the controversies and myths concerning the initiation, maintenance, and discontinuation of epidural analgesia. Recent evidence will also be reviewed to address concerns about the effects of epidural analgesia on the rates of instrumental and operative delivery, lower back pain, and breastfeeding. New developments in labour analgesia are also discussed.

疼痛緩解是現代產科護理的重要部分，可以通過椎管內、全身或吸入鎮痛或各種非藥物技術達到減痛效果。本文回顧有關技術的有效性和安全性的最新研究。過去十年，更安全的局部麻醉藥、超短效鴉片類藥物、脊柱硬膜外聯合針刺、病人自控鎮痛設備，以及超聲檢查技術已徹底改變產科局部的鎮痛方式。近年的薈萃分析支持硬膜外鎮痛是最有效的技術，因為它可提高產婦的滿意度以及產婦和胎兒的安全。我們檢視有關開始、維持和停止硬膜外鎮痛的爭議和迷思，並透過近年研究探討硬膜外鎮痛對陰道助產和手術分娩率、腰痛和母乳喂養率影響的憂慮。我們也討論分娩鎮痛的最新進展。