Miller School of Medicine, University of Miami, Florida, USA.
Int J Womens Health. 2010 Aug 9;1:31-43. doi: 10.2147/ijwh.s4552.
Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.
椎管内镇痛被广泛认为是分娩中最有效且最不易产生抑制的缓解疼痛的方法。在过去的几十年中，椎管内分娩镇痛技术和药物已经发展到了这样一个阶段：它们为母亲和胎儿提供高质量的疼痛缓解，同时最小化副作用，同时使接受椎管内镇痛的产妇尽可能自主。联合脊髓-硬膜外技术的引入使得镇痛能够快速起效，同时最小化运动阻滞，从而使产妇能够舒适地行走。患者自控硬膜外镇痛技术已经发展到允许更灵活的镇痛，以适应产妇的个体需求，并在分娩的不同阶段都有效。计算机集成系统已被研究用于提供从椎管内阻滞诱导到分娩的无缝镇痛。新的辅助药物可以提高椎管内分娩镇痛的效果，同时减少由于单一药物高剂量可能引起的副作用，这些药物可能会被添加到未来的分娩镇痛实践中。布比卡因仍然是分娩镇痛中常用的局部麻醉药。已经引入了一些心脏毒性较小的新型局部麻醉药，但它们在当前分娩镇痛实践中的成本效益受到了质疑。
