BC Women's Hospital, Department of Anesthesia, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, MA, USA.
Best Pract Res Clin Anaesthesiol. 2022 May;36(1):3-15. doi: 10.1016/j.bpa.2022.04.004. Epub 2022 Apr 22.
The ideal technique for labor analgesia would have a quick onset, predictable quality, and adjustable depth and duration. Moreover, it would be easy to perform and have minimal maternal and fetal side effects. A catheter-based neuraxial approach encompasses these desirable characteristics and includes the epidural, combined spinal epidural, dural puncture epidural, and intrathecal catheter techniques. In this review, we outline the unique technical considerations, analgesic characteristics, and side effect profiles for each technique that can ultimately impact the maternal-fetal dyad. The selection of neuraxial analgesia techniques should consider the patient and team's goals and expectations, the clinical context, and the institutional culture. Labor analgesic techniques that initiate with an intentional dural puncture component have a faster onset, greater bilateral and sacral spread, and lower rates of epidural catheter failure. Further elucidation of the mechanisms, benefits, and risks of each neuraxial initiation technique will continue to benefit patients and care providers.
分娩镇痛的理想技术应具有起效迅速、质量可预测、深度和持续时间可调等特点。此外，还应易于操作，且对母婴的副作用最小。基于导管的脊神经轴方法具有这些理想的特征，包括硬膜外、联合脊髓硬膜外、硬膜穿刺硬膜外和鞘内导管技术。在这篇综述中，我们概述了每种技术的独特技术考虑因素、镇痛特性和副作用特征，这些因素最终会影响母婴对子代。脊神经轴镇痛技术的选择应考虑患者和团队的目标和期望、临床环境和机构文化。以有意硬膜穿刺为起始的分娩镇痛技术具有更快的起效时间、更大的双侧和骶骨扩散以及更低的硬膜外导管失败率。进一步阐明每种脊神经轴起始技术的机制、益处和风险将继续使患者和医护人员受益。
