NEURAXIAL TECHNIQUE FOR LABOR ANALGESIA: CURRENT TRENDS
Journal
Macedonian Journal of Anaetshesia
Date Issued
2023-12
Author(s)
Abstract
Intense pain during labor can cause some adverse effects in parturient, like uncoordinated uterine
contractions, prolonged duration, or stalled labor, as one of the most important reasons leading to
caesarean section (C-S) worldwide. Unrelieved labor pain, which can lead to post-traumatic stress
disorder or postpartum depression, in addition to discomfort, causes physiological stress that
has an adverse effect on the mother and the newborn. Unrelieved pain stimulates catecholamine
release, it causes hyperventilation and hypocapnia, which further constricts uterine blood
vessels, reduces ventilation stimulus between contractions, causing a leftward shift of the oxygen
dissociation curve; and all these phenomena compromise oxygen supply to the fetus, leading to
fetal hypoxemia. Premature “movement down” of the fetus can lead to a canal trauma and injury
during childbirth; parenteral opioids may exacerbate maternal respiratory depression, while
regional (neuraxial) analgesia may reduce adverse effects of labor pain and sympathetic system
responsiveness. Therefore, good labor analgesia aims not only to reduce the pain and suffering of
the parturient, but also decreases the risk of fetal acidemia and, in general, makes the labor process
safer, both for the mother and neonate.
contractions, prolonged duration, or stalled labor, as one of the most important reasons leading to
caesarean section (C-S) worldwide. Unrelieved labor pain, which can lead to post-traumatic stress
disorder or postpartum depression, in addition to discomfort, causes physiological stress that
has an adverse effect on the mother and the newborn. Unrelieved pain stimulates catecholamine
release, it causes hyperventilation and hypocapnia, which further constricts uterine blood
vessels, reduces ventilation stimulus between contractions, causing a leftward shift of the oxygen
dissociation curve; and all these phenomena compromise oxygen supply to the fetus, leading to
fetal hypoxemia. Premature “movement down” of the fetus can lead to a canal trauma and injury
during childbirth; parenteral opioids may exacerbate maternal respiratory depression, while
regional (neuraxial) analgesia may reduce adverse effects of labor pain and sympathetic system
responsiveness. Therefore, good labor analgesia aims not only to reduce the pain and suffering of
the parturient, but also decreases the risk of fetal acidemia and, in general, makes the labor process
safer, both for the mother and neonate.
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