Department of Anesthesiology, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, USA.
Am J Ther. 2010 Sep-Oct;17(5):492-7. doi: 10.1097/MJT.0b013e3181ea7838.
Labor analgesia researchers have pursued better and safer ways to provide pain relief in labor. Although some pharmacologic investigations have focused on alternative mechanisms to target and medications to employ, a large part of the recent obstetric anesthesiology literature has contributed toward the safety and efficacy of techniques dependent on traditional therapeutics, specifically local anesthetics given through a neuraxial anesthetic technique. Investigators have worked to demonstrate and remove doubts that neuraxial anesthesia can be a safe method of labor analgesia. Pharmacodynamic studies during the last 3 decades have revealed ways to achieve adequate analgesia with minimal doses and correspondingly minimal risks. Dose-sparing opiate adjuncts to local anesthetics are now commonplace. To avoid excessive dosages, clinical up-down sequential allocation experiments identified the minimum amounts of local analgesia needed. Modifications to the administration of drug allowed total doses to be further reduced. This historical overview highlights some of these important advances in the present and recent past of neuraxial labor analgesia, and it traces how desired outcomes are being achieved with less and less total drug.
分娩镇痛研究人员一直在寻求更好、更安全的方法来缓解分娩疼痛。虽然一些药理学研究集中在针对替代机制和使用药物的方法上，但最近的产科麻醉学文献的很大一部分都有助于证明传统疗法的安全性和有效性，特别是通过椎管内麻醉技术给予局部麻醉剂。研究人员努力证明并消除了对椎管内麻醉可以作为一种安全的分娩镇痛方法的疑虑。过去 30 年的药效动力学研究揭示了如何用最小剂量实现足够的镇痛效果，相应地也将风险降到最低。现在局部麻醉剂中常加入阿片类药物辅助剂来减少剂量。为了避免过量用药，临床上下序贯分配实验确定了所需的最小局部镇痛剂量。药物给药方式的改变进一步减少了总剂量。本文的历史回顾强调了椎管内分娩镇痛的当前和过去的一些重要进展，它追踪了如何用越来越少的总药物来实现预期的结果。
