University of Toronto and Sunnybrook Health Sciences Centre, Division of Obstetrical Anesthesia, Toronto, Canada.
Curr Opin Anaesthesiol. 2010 Jun;23(3):317-22. doi: 10.1097/ACO.0b013e3283385492.
Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration.
Compared with parenteral opioids, neuraxial analgesia does not increase the incidence of cesarean section, although it is associated with a longer (approximately 16 min) second stage of labor. The incidence of operative vaginal delivery is higher in the epidural group but this may be due to indirect reasons such as changes in physician behavior. There was no difference in labor outcome when CSE was compared with low-concentration epidural analgesia, but higher concentrations may prolong labor. Early administration of neuraxial analgesia does not increase the incidence of operative delivery or prolong labor.
Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.
分娩疼痛是人类经历的最痛苦的体验之一。椎管内镇痛是治疗这种疼痛最有效的方法。在这篇综述中，我们讨论了与鞘内阿片类药物相比，椎管内镇痛对产程进展的影响。然后，我们比较了联合腰麻-硬膜外麻醉（CSE）与传统硬膜外镇痛的镇痛起始时间。最后，我们讨论了与晚期给药相比，产程早期给予椎管内镇痛的影响。
与鞘内阿片类药物相比，椎管内镇痛并不会增加剖宫产的发生率，尽管其第二产程（约 16 分钟）较长。硬膜外组的阴道助产分娩发生率较高，但这可能是由于医生行为等间接原因发生了变化。CSE 与低浓度硬膜外镇痛相比，分娩结局没有差异，但浓度较高可能会延长产程。早期给予椎管内镇痛不会增加剖宫产率或延长产程。
椎管内镇痛不会干扰产程的进展或结局。无需等到活跃期才开始椎管内镇痛。
