Department of Anaesthesiology, The University of Hong Kong, Hong Kong.
Hong Kong Med J. 2020 Oct;26(5):413-420. doi: 10.12809/hkmj208632. Epub 2020 Sep 17.
Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it leads to higher maternal satisfaction and good maternal and fetal safety profiles. We examine the controversies and myths concerning the initiation, maintenance, and discontinuation of epidural analgesia. Recent evidence will also be reviewed to address concerns about the effects of epidural analgesia on the rates of instrumental and operative delivery, lower back pain, and breastfeeding. New developments in labour analgesia are also discussed.
疼痛缓解是现代产科护理的一个重要组成部分，可以通过神经轴、全身或吸入性镇痛或各种物理技术来实现。我们回顾了这些技术的最新疗效和安全性证据。在过去的十年中，更安全的局部麻醉剂、超短效阿片类药物、联合硬膜外针、患者自控镇痛装置和超声技术的出现彻底改变了产科区域镇痛。最近的荟萃分析支持硬膜外镇痛作为最有效的技术，因为它能提高产妇满意度，并具有良好的母婴安全性。我们检查了关于硬膜外镇痛启动、维持和停止的争议和误解。最近的证据也将被审查，以解决对硬膜外镇痛对器械和手术分娩、腰痛和母乳喂养率的影响的担忧。还讨论了分娩镇痛的新进展。
