Reducing breakthrough pain during labour epidural analgesia: an update

被引:17
|
作者
Sen Tan, Hon [1 ]
Sng, Ban Leong [1 ,2 ]
Sia, Alex Tiong Heng [1 ,2 ]
机构
[1] KK Womens & Childrens Hosp, Dept Womens Anaesthesia, Singapore, Singapore
[2] Duke NUS Med Sch, Anaesthesiol & Perioperat Sci Acad Clin Program, Singapore, Singapore
关键词
breakthrough pain; epidural analgesia; labour pain; local anaesthetics; RANDOMIZED CONTROLLED-TRIAL; DURAL PUNCTURE; BACKGROUND INFUSION; INTRAVENOUS REMIFENTANIL; NEURAXIAL ANALGESIA; WHITACRE NEEDLE; BASAL INFUSION; RISK-FACTORS; PATIENT; ANESTHESIA;
D O I
10.1097/ACO.0000000000000713
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose of review Neuraxial techniques are the current gold standard for labour analgesia, but are associated with up to 25% incidence of breakthrough pain. In this review, we aim to update clinicians on the latest research pertaining to the optimization of neuraxial labour analgesia. Recent findings Attempts to improve the efficacy and reliability of epidural analgesia while minimizing adverse effects have resulted in the rising popularity of combined spinal epidural and the dural puncture epidural (DPE). Recent studies have focused on determining the safety, efficacy, and optimization of the DPE technique. Another research focus is on the development of individualized therapy in which patients may titrate their own labour analgesia according to their varying requirements, possibly augmented with computer-aided feedback systems and automated mandatory bolus techniques that automatically adjust drug delivery to the patients' analgesic requirements. The addition of a risk-stratification model based on maternal, anaesthetic, and obstetric factors will facilitate early institution of individualized therapy to forestall breakthrough pain in higher risk patients. Summary Recent advances in combined spinal epidural, DPE, automated mandatory bolus, and individualized therapies have advanced our goal of providing effective labour analgesia that is titrated to changing analgesic requirements during labour and delivery and reducing breakthrough pain.
引用
收藏
页码:307 / 314
页数:8
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