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Neuraxial analgesia for labor and delivery (including instrumented delivery)

Authors
Roulhac d'Arby Toledano, MD, PhD
Lisa Leffert, MD
Section Editor
David L Hepner, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Neuraxial analgesia is the most effective and most commonly used therapy for pain relief during labor and delivery. Epidural, combined spinal–epidural (CSE), and other central neuraxial techniques, including dural puncture epidural (DPE), single-shot spinal, and continuous spinal, are among the many options available to alleviate the pain of childbirth. In most cases, these techniques provide excellent analgesia with minimal risk to both mother and fetus.

This topic will discuss the indications, common techniques, and drugs used for neuraxial labor analgesia. The pain pathways applicable to labor and delivery, other pharmacologic methods for control of labor pain, neuraxial techniques, and adverse effects of neuraxial block are discussed in detail separately. (See "Pharmacologic management of pain during labor and delivery", section on 'Pain pathways' and "Pharmacologic management of pain during labor and delivery", section on 'Adverse consequences of labor pain' and "Adverse effects of neuraxial analgesia and anesthesia for obstetrics" and "Spinal anesthesia: Technique".)

INDICATIONS FOR NEURAXIAL ANALGESIA

Neuraxial labor analgesia may be performed to relieve the pain of labor and to provide an in-situ epidural catheter for rapid conversion to surgical anesthesia for operative delivery, should it become necessary.

Pain relief — Neuraxial analgesia is appropriate for laboring women regardless of parity, cervical dilation, and fetal station, unless there is a contraindication [1]. The techniques are usually easily performed, life-threatening complications are rare, and side effects such as pruritus and hypotension are transient or easily treated. The following general considerations apply to neuraxial analgesia for labor:

The American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) concur that maternal request is sufficient indication for pain relief during labor, barring a medical contraindication [1].

                                     

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 22 00:00:00 GMT 2016.
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References
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