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Chapter 49 - Analgesia and Anaesthesia during Labour

from Section 5 - Intrapartum Care

Published online by Cambridge University Press:  20 November 2021

By
Britt Ingjerd Nesheim
Edited by
Tahir Mahmood ,
Charles Savona Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Childbirth is painful. During the first stage of labour, pain originates in the uterus and cervix. It is caused by ischaemia during contractions and traction on tissue fibres during distention of the cervix. Visceral sensory nerve fibres traverse into the pelvic plexus, and from there to the spinal cord at the level of T10 to L1. During the second stage, pain originates from distention of the vagina, perineum and the pelvic floor. The pudendal nerve transmits the pain signals to the spinal cord at the level of S2–S4.

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
 , pp. 403 - 408
Publisher: Cambridge University Press
Print publication year: 2021

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References

Reed, PN, Colquhoun, AD, Hanning, CD. Maternal oxygenation during normal labour. Br J Anaesth. 1989;62:316–18.CrossRefGoogle ScholarPubMed
Janbu, T, Koss, KS, Nesheim, BI, Wesche, J. Blood velocities in the uterine artery in humans during labour. Acta Physiol Scand. 1985;124:153–61.CrossRefGoogle ScholarPubMed
Hingson, RA, Edwards, WB. Continuous caudal analgesia in obstetrics. JAMA. 1943;121(4):225–9.Google Scholar
Pearson, JF, Davies, P. The effect of continuous lumbar epidural analgesia on the acid-base status of maternal arteial blood during the first stage of labour. BJOG. 1973;80:218–24.Google Scholar
Toledano, R d’A. Neuraxial analgesia for labor and delivery (including instrumented delivery). In Hepner, DL, ed. UpToDate. Waltham, MA: UpToDate Inc.; [cited 2019 July 26]. www.uptodate.com/contents/neuraxial-analgesia-for-labor-and-delivery-including-instrumented-delivery?search=labor%20analgesia&source=search_result&selectedTitle=1~60&usage_type=default&display_rank=1.Google Scholar
Grant, GJ. Adverse effects of neuraxial analgesia and anesthesia for obstetrics. In Hepner, DL, ed. UpToDate. Waltham, MA: UpToDate Inc.; [cited 2019 July 09]. www.uptodate.com/contents/adverse-effects-of-neuraxial-analgesia-and-anesthesia-for-obstetrics?search=labor+analgesia&topicRef=101803&source=related_link.Google Scholar
Simmons, SW, Taghizadeh, N, Dennis, AT, Hughes, D, Cyna, AM. Combined spinal‐epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012 Oct 17; (10):CD003401.Google ScholarPubMed
Choi, PT, Galinski, SE, Takeuchi, L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth. 2003;50(5):460–9.CrossRefGoogle ScholarPubMed
Kjellberg, F, Tramèr, MR. Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials. Eur J Anaesthesiol 2001;18(6):346–57.CrossRefGoogle ScholarPubMed
Chen, CT. Intrapartum fever. In Berghella, V, Hepner, DL, eds. UpToDate. Waltham, MA: UpToDate Inc.; [cited 2019 July 10]. www.uptodate.com/contents/intrapartum-fever?search=labor+analgesia&topicRef=4469&source=see_link#H483714642.Google Scholar
Anim‐Somuah, M, Smyth, RMD, Cyna, AM, Cuthbert, A. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018 May 21;(5):CD000331.Google ScholarPubMed
Rosenfeld, SS. Paracervical anesthesia for the relief of labor pains. Am J Obstet Gynecol. 1945;50(5):527–32.CrossRefGoogle Scholar
Novikova, N, Cluver, C. Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD009200.Google Scholar
Palomäki, O, Huhtala, H, Kirkinen, P. A comparative study of the safety of 0.25% levobupivacaine and 0.25% racemic bupivacaine for paracervical block in the first stage of labor. Acta Obstet Gynecol Scand. 2005;84(10):956–61.CrossRefGoogle ScholarPubMed
Vidaeff, AC. Pudendal and paracervical block. In Berghella, V, Hepner, DL, eds. UpToDate. Waltham, MA: UpToDate Inc.; [cited 2019 July 10]. www.uptodate.com/contents/pudendal-and-paracervical-block?search=paracervical%20block&source=search_result&selectedTitle=1~39&usage_type=default&display_rank=1.Google Scholar
Smith, LA, Burns, E, Cuthbert, A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018 Jun;(6):CD007396.Google ScholarPubMed
Cowan, A, Geller, EB, Adler, MW. Classification of opioids on the basis of change in seizure threshold in rats. Science. 1979;206(4417):465–7.CrossRefGoogle ScholarPubMed
Schnabel, A, Hahn, N, Broscheit, J, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2012;29(4):177–85.CrossRefGoogle ScholarPubMed
Muchatuta, NA, Kinsella, SM. Remifentanil for labour analgesia: time to draw breath? Anaesthesia. 2013;68(3):231–5.CrossRefGoogle ScholarPubMed
Grant, GJ. Pharmacologic management of pain during labor and delivery. In Hepner, DL, Berghella, V, eds. UpToDate. Waltham, MA: UpToDate Inc.; [cited 2019 June 26]. www.uptodate.com/contents/pharmacologic-management-of-pain-during-labor-and-delivery?search=labor%20analgesia&source=search_result&selec.Google Scholar
Fleet, J, Belan, I, Jones, M, Ullah, S, Cyna, A. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG. 2015;122(7):983–92.Google Scholar
Klomp, T, van Poppel, M, Jones, L, et al. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD009351.Google ScholarPubMed
Likis, FE, Andrews, JC, Collins, MR, et al. Nitrous oxide for the management of labor pain: a systematic review. Anesthesia Analgesia. 2014;118(1):153–67.CrossRefGoogle ScholarPubMed
Simkin, P, Klein, MC. Nonpharmacologic approaches to management of labor pain. In Lockwood, CJ. ed. UptoDate. Waltham, MA: UpToDate Inc.; [cited 2019 June 27]. www.uptodate.com/contents/nonpharmacologic-approaches-to-management-of-labor-pain?search=labor%20analgesia&topicRef=4468&source=see_link.Google Scholar
Lawrence, A, Lewis, L, Hofmeyr, GJ, Styles, C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013 Oct 9;(10):CD003934.Google ScholarPubMed
Smith, CA, Levett, KM, Collins, CT, et al. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. 2018 Mar 28;(3):CD009514.Google ScholarPubMed
Smith, CA, Collins, CT, Crowther, CA. Aromatherapy for pain management in labour. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009215.Google ScholarPubMed
Melzack, R. Myofascial trigger points: relation to acupuncture and mechanisms of pain. Arch Phys Med Rehab. 1981;62(3):114–17.Google ScholarPubMed
Smith, CA, Collins, CT, Crowther, CA, Levett, KM. Acupuncture or acupressure for pain management in labour. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009232.Google ScholarPubMed
Derry, S, Straube, S, Moore, RA, Hancock, H, Collins, SL. Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Cochrane Database Syst Rev. 2012 Jan;(1).Google Scholar
Dowswell, T, Bedwell, C, Lavender, T, Neilson, JP. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007214.Google Scholar
Cluett, ER, Burns, E, Cuthbert, A. Immersion in water during labour and birth. Cochrane Database Syst Rev. 2018 May;(5):CD000111.Google ScholarPubMed
Barragán Loayza, IM, Solà, I, Juandó Prats, C. Biofeedback for pain management during labour. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD006168.Google ScholarPubMed

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