Labor Pain Pathophysiology and Analgesic Options

2017 ◽  
Author(s):  
Ben Homra ◽  
Alan D. Kaye ◽  
Elyse Cornett ◽  
Justin Creel ◽  
Matthew B. Novitch ◽  
...  
Keyword(s):  
The United States ◽  
Labor Pain ◽  
Epidural Fentanyl ◽  
Patient Controlled Analgesia ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Therapeutic Massage ◽  
Recent Trends ◽  
Key Words Epidural ◽  
Exercise During Pregnancy

Regional neuraxial blocks, such as spinal and epidural anesthetics, are used for most women in the United States for labor pain. They are the most effective methods for preserving consciousness and the ability to participate in the second stage of labor. Regional neuraxial blocks may be augmented by combining spinal and epidural techniques, postlabor nonopioids and opioids, distraction therapy, and patient-controlled analgesia. In addition, several alternative analgesic methods have been recently recommended for labor pain without consensus on their respective efficacies, including yoga, exercise during pregnancy, acupuncture, hypnotism, hydrotherapy, and therapeutic massage. This review focuses on current updates and recent trends in labor pain management, the pathophysiology of labor pain, and the basic mechanisms supporting the efficacies of systemic, inhalation, neuraxial, and local analgesia during labor.  Key words: epidural, fentanyl, labor pain, local anesthetic, spinal analgesia

Labor Pain Pathophysiology and Analgesic Options

2017 ◽  
Author(s):  
Ben Homra ◽  
Alan D. Kaye ◽  
Elyse Cornett ◽  
Justin Creel ◽  
Matthew B. Novitch ◽  
...  
Keyword(s):  
The United States ◽  
Labor Pain ◽  
Epidural Fentanyl ◽  
Patient Controlled Analgesia ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Therapeutic Massage ◽  
Recent Trends ◽  
Key Words Epidural ◽  
Exercise During Pregnancy

Regional neuraxial blocks, such as spinal and epidural anesthetics, are used for most women in the United States for labor pain. They are the most effective methods for preserving consciousness and the ability to participate in the second stage of labor. Regional neuraxial blocks may be augmented by combining spinal and epidural techniques, postlabor nonopioids and opioids, distraction therapy, and patient-controlled analgesia. In addition, several alternative analgesic methods have been recently recommended for labor pain without consensus on their respective efficacies, including yoga, exercise during pregnancy, acupuncture, hypnotism, hydrotherapy, and therapeutic massage. This review focuses on current updates and recent trends in labor pain management, the pathophysiology of labor pain, and the basic mechanisms supporting the efficacies of systemic, inhalation, neuraxial, and local analgesia during labor.  Key words: epidural, fentanyl, labor pain, local anesthetic, spinal analgesia

scholarly journals Effects of Continuous Use of Entonox in Comparison with Intermittent Method on Obstetric Outcomes: A Randomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Jila Agah ◽  
Roya Baghani ◽  
Seid Hossein Safiabadi Tali ◽  
Yaser Tabarraei
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Face Mask ◽  
Labor Pain ◽  
Continuous Group ◽  
Obstetric Outcomes ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Significant Difference ◽  
Continuous Use

Background. Entonox (N2O2) which is an inhalational gas for relieving labor pain is commonly used intermittently; however some women are interested in continuous breathing in face mask. So we decided to compare the complications induced by two methods to find out whether it is safe to permit the mothers to use Entonox continuously or not.Patients and Methods. This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. 50 parturients used Entonox intermittently and 50 cases used it continuously during labor. Then obstetrical outcomes were analyzed in two groups by spss 17 software,t-test, and Chi2whileP<0.05was considered significant.Results. This study showed the mean duration of second stage of labor had no significant difference (P=0.3). Perineal laceration was less in continuous group significantly (P=0.04). Assisted vaginal birth was not different significantly (P=0.4). Uterine atony had no significant difference in two groups (P=0.2). Maternal collaboration in pushing and satisfaction were higher in continuous group significantly (P=0.03), (P<0.0001). Apgar score of neonates at first and fifth minute was acceptable and not different significantly in two groups (P=0.3).Conclusions. Our study demonstrated continuous method is also safe. So, it seems reasonable to set mothers free to choose the desired method of Entonox usage.

scholarly journals Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

2015 ◽  
Vol 28 (1) ◽  
pp. 70 ◽  
Author(s):  
José Manuel Costa-Martins ◽  
Cláudia Camila Dias ◽  
Marco Pereira ◽  
Jorge Tavares
Keyword(s):  
Epidural Analgesia ◽  
Prospective Study ◽  
Local Anesthetic ◽  
Low Dose ◽  
Labor Pain ◽  
Neuraxial Blockade ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Group I ◽  
Group Ii

<p><strong>Background:</strong> Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 μg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 μg.ml-1 sufentanil) on the intervals between boluses and the duration of labor.<br /><strong>Material and Methods:</strong> In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil) and Group II (n = 57; 0.6 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded.<br /><strong>Results:</strong> The ropivacaine dose was greater in Group I (9.5 [7.7-12.7] mg.h-1 vs. 6.1 [5.1-9.8 mg.h-1], p &lt; 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p &lt; 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI [-2.44; -0.36], p = 0.009). The duration of the second stage of labor in Group I was significantly longer<br />than that in Group II (78 min vs. 65 min, p &lt; 0.001).<br /><strong>Conclusions:</strong> Parturients receiving 0.06% ropivacaine exhibited less evidence of cumulative effects and exhibited faster second stage progression than those who received 0.1% ropivacaine.<br /><strong>Keywords:</strong> Analgesia, Obstetrical; Analgesia, Patient-Controlled; Labor Pain; Ropivacaine; Sufentanil.</p>

scholarly journals Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study

2018 ◽  
Vol 15 (10) ◽  
pp. 2092 ◽  
Author(s):  
Antonio Martínez ◽  
Julián Almagro ◽  
María García-Suelto ◽  
María Barrajon ◽  
Milagros Alarcón ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Neonatal Morbidity ◽  
Labor Pain ◽  
Instrumental Delivery ◽  
Normal Vaginal Delivery ◽  
Historical Cohort ◽  
Second Stage Of Labor ◽  
Confounding Bias ◽  
Second Stage ◽  
Labor Duration

(1) Background: Epidural analgesia (EA), at the present time, is one of the most effective methods to reduce labor pain. In recent years its use has increased, being used between 20–70% of all deliveries; (2) Methods: Historical cohort on a total of 2947 deliveries during the years 2012–2016 at the “Mancha-Centro Hospital” of Alcázar de San Juan. The main outcome variables were four neonatal morbidity (NM) criteria: umbilical artery pH of <7.10, Apgar score at 5 min < 7, need for advanced resuscitation and composite morbidity. We used the multivariate analysis to control confounding bias. (3) Results: No statistical relationship between EA and the second stage of labor duration with none of the four criteria of NM used (p > 0.005). However, the type of delivery was associated with three criteria (pH, resuscitation, and composite morbidity). The instrumental delivery presented an OR of pH < 7.10 of 2.68 95% CI [1.15, 6.27], an OR of advanced resuscitation of 2.44 95% CI [1.17, 5.08] and OR of composite morbidity of 2.86 95% CI [1.59, 5.12]; (4) Conclusions: The EA and the second stage of labor duration are not related to the NM. While the instrumental delivery doubles the risk of NM compared to the normal vaginal delivery.

The Natural History of the Normal First Stage of Labor

2021 ◽  
pp. 97-102
Author(s):  
Karin Fox
Keyword(s):  
United States ◽  
Natural History ◽  
20Th Century ◽  
Secondary Analysis ◽  
The United States ◽  
Single Center ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
History Of ◽  
The Individual

This article provides a summary of a landmark study on labor, in a large, multicenter modern cohort of women with singleton, vertex gestations. Emanuel Friedman published his original labor curve showing the expected progression of normal labor in 1955, and that for multiparous patients in 1956.2,3 He plotted the individual labor progression of 500 nulliparous laboring women from a single center to calculate the average progression of labor. In his cohort, 70% of whom were between 20 and 30 years old, many were Caucasian, and 55% of women were delivered via forceps. Dr. Friedman classically identified the second stage of labor starting at 4cm dilatation. Since the mid-20th century, many practice patterns have changed, and today’s population of women delivering in the United States is diverse and, on average, older and heavier than in 1955; therefore, use of the traditional labor curve has been questioned. The investigators in this study performed a secondary analysis of data from a multicenter cohort of 26,838 patients with singleton gestation, spontaneous labor, and normal outcomes. Using a sophisticated statistical approach Zhang et al. produced a modern labor curve.

Second stage of labor in the age of epidural anesthesia

1998 ◽  
Vol 5 (1) ◽  
pp. 171A-171A
Author(s):  
E XENAKIS ◽  
J PIPER ◽  
M MCFARLAND ◽  
C SUITER ◽  
O LANGER
Keyword(s):  
Epidural Anesthesia ◽  
Second Stage Of Labor ◽  
Second Stage

Translabial ultrasound in the second stage of labor

Choonpa Igaku ◽  
2016 ◽  
Vol 43 (3) ◽  
pp. 457-465
Author(s):  
Koichi KOBAYASHI ◽  
Miki GOTO ◽  
Ken SAKAMAKI
Keyword(s):  
Translabial Ultrasound ◽  
Second Stage Of Labor ◽  
Second Stage
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