Epidural analgesia for labor and delivery.

@article{Hawkins2010EpiduralAF,
  title={Epidural analgesia for labor and delivery.},
  author={Joy L. Hawkins},
  journal={The New England journal of medicine},
  year={2010},
  volume={362 16},
  pages={
          1503-10
        }
}
  • J. Hawkins
  • Published 6 May 2010
  • Medicine
  • The New England journal of medicine
A 30-year-old pregnant woman is undergoing induction of labor and is experiencing severe pain despite intravenous opioid administration. Epidural analgesia is recommended. Epidural analgesia involves the injection of a local anesthetic agent and an opioid analgesic agent into the lumbar epidural space. These agents diffuse across the dura and act on the spinal nerve roots. Rates of cesarean delivery are not increased with epidural analgesia. 
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135 Citations

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Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally
TLDR
There is a need for further studies to improve the safety and quality of labor and delivery care in parturient women.
Puerperal ventral epidural hematoma after epidural labor analgesia.
Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity
TLDR
Increasing the access to and utilization of labor neuraxial analgesia may help reduce severe maternal morbidity and improve maternal health outcomes.
Statistics on Epidural Analgesia Made on Admitted Patients for Normal Vaginal Delivery, Outcome Results and Benefits
TLDR
Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU.
Neuraxial labor analgesia: a literature review
To study the effect of epidural analgesia on second stage of labor and mode of delivery
TLDR
It was found that the pain was reduced significantly in the mothers after receiving the epidural analgesia and can be safely recommended as a method of labor analgesia.
Perinatal outcomes: Intravenous patient‐controlled fentanyl versus no analgesia in labor
To investigate perinatal outcomes, the analgesic efficacy and maternal satisfaction in nulliparous women receiving fentanyl intravenous patient‐controlled analgesia (i.v.‐PCA).
The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study.
TLDR
Epidural analgesia can prolong the second stage of labor, but this is no increased risk for both mother and neonate.
Delivery mode and maternal and neonatal outcomes of combined spinal–epidural analgesia compared with no analgesia in spontaneous labor: A single‐center observational study in Japan
We aimed to assess the outcomes of combined spinal–epidural (CSE) analgesia compared with no analgesia in spontaneous labor.
The Value of Programmed Intermittent Epidural Bolus in Labor Analgesia
TLDR
The use of programmed intermittent bolus combined with PECA was more effective than continuous infusion combined withPECA, it could be useful as the mode of maintenance for epidural labor analgesia.
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References

SHOWING 1-10 OF 64 REFERENCES
Lumbar Epidural Analgesia to Improve Intervillous Blood Flow During Labor in Severe Preeclampsia
TLDR
Intervillous blood flow was measured during the first stage of labor in 9 parturients with severe preeclampsia before and after lumbar epidural analgesia, suggesting that epidural opioid analgesia is the obstetric analgesic method of choice in cases of severe preeClampsia.
Randomized Trial of Epidural Versus Intravenous Analgesia During Labor
The risk of cesarean delivery with neuraxial analgesia given early versus late in labor.
TLDR
Neuraxial analgesia in early labor did not increase the rate of cesarean delivery, and it provided better analgesia and resulted in a shorter duration of labor than systemic analgesia.
Epidural versus non-epidural or no analgesia in labour.
TLDR
Epidural analgesia appears to be effective in reducing pain during labour, however, women who use this form of pain relief are at increased risk of having an instrumental delivery and further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesIA on women in labour and long-term neonatal outcomes.
Comparison of epidural analgesia with combined spinal-epidural analgesia for labor: a retrospective study of 6497 cases.
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TLDR
Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.
Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation.
TLDR
Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.
Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review
TLDR
Epidural analgesia using low concentration infusions of bupivacaine with parenteral opioid analgesia is unlikely to increase the risk of caesarean section but may increase therisk of instrumental vaginal delivery.
Economic Considerations Related to Providing Adequate Pain Relief for Women in Labour
TLDR
A rational social policy for providing labour analgesia must weigh the value of improved pain relief from epidural morphine against the increased cost of epidural analgesia.
Early versus Late Initiation of Epidural Analgesia in Labor: Does It Increase the Risk of Cesarean Section? A Randomized Trial
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