Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), 513 Parnassus Ave, MSB, 436, Box 0427, San Francisco, CA 94143, USA.
Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA.
Best Pract Res Clin Anaesthesiol. 2022 May;36(1):17-30. doi: 10.1016/j.bpa.2022.03.001. Epub 2022 Mar 24.
Since the advent of neuraxial analgesia for labor, approaches to maintaining intrapartum pain relief have seen significant advancement. Through pharmacologic innovations and improved drug delivery mechanisms, current neuraxial labor analgesia maintenance techniques have been shaped by efforts to maximize patient comfort during the birthing process, while minimizing undesirable side effects and promoting the unimpeded progress of labor. To these ends, a modern anesthesiologist may avail themselves of several techniques, including programmed intermittent epidural bolus (PIEB), patient controlled epidural analgesia (PCEA) and dilute concentration local anesthetic + opioid epidural solutions. We explore the historical development and the evidential underpinnings of these techniques, in addition to several contemporary neuraxial labor analgesia practices. We also summarize current understanding of the effects these interventions have on maternal/fetal health and the labor course, as well as several important aspects of analgesic safety and monitoring.
自从分娩时使用椎管内镇痛以来，维持分娩镇痛的方法已经取得了重大进展。通过药理学创新和改进的药物输送机制，目前的椎管内分娩镇痛维持技术旨在最大程度地提高分娩过程中的患者舒适度，同时最大限度地减少不良副作用并促进分娩的顺利进行。为此，现代麻醉师可以采用几种技术，包括程控间歇硬膜外推注（PIEB）、病人自控硬膜外镇痛（PCEA）和稀释浓度局部麻醉药+阿片类药物硬膜外溶液。我们探讨了这些技术的历史发展和证据基础，以及几种当代椎管内分娩镇痛实践。我们还总结了目前对这些干预措施对母婴/胎儿健康和分娩过程的影响的理解，以及镇痛安全性和监测的几个重要方面。
