Ortiz-Gómez J R, Palacio-Abizanda F J, Fornet-Ruiz I
Servicio de Anestesiología, Complejo Hospitalario de Navarra, Pamplona, 31008, Spain.
An Sist Sanit Navar. 2014 Sep-Dec;37(3):411-27. doi: 10.4321/s1137-66272014000300010.
Epidural analgesia is now the method of choice for the treatment of pain in labour and delivery. However, this technique may fail and provide inadequate or null alleviation to the mother. This paper reviews the risk factors, possible causes and possible therapeutic alternatives to inadequate analgesia, whether pharmacological therapies (neuroaxial, peripheral blocks or analgesic administration via intravenous or inhalational routes) or non-pharmacological ones (relaxation techniques, psychological or mechanical). In all possible cases the efficacy and indications of alternative therapies based on the published literature are reviewed, especially from the point of view of evidence-based medicine. The need is underscored of a multifactorial therapeutic approach to the pregnant woman, not just restricting ourselves to eliminating the pain of childbirth.
硬膜外镇痛现已成为分娩期疼痛治疗的首选方法。然而，该技术可能会失败，无法为产妇提供充分的缓解或根本无法缓解疼痛。本文综述了镇痛不足的风险因素、可能原因以及可能的治疗替代方案，包括药物治疗（神经轴阻滞、外周阻滞或经静脉或吸入途径给药镇痛）和非药物治疗（放松技术、心理或物理方法）。在所有可能的情况下，均根据已发表的文献综述替代疗法的疗效和适应证，尤其是从循证医学的角度进行综述。强调了对孕妇采取多因素治疗方法的必要性，而不仅仅局限于消除分娩疼痛。
