Current state of anesthesia for labor

Pismensky S.V., Zolotareva L.S., Baev O.R., Abdulaev A.M., Darbinyan V.O., Pyregov A.V.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
The review considers rational methods to control pain during labor, which are the leading criteria for the standards of modern obstetrics. There are various pharmacological and non-pharmacological options for pain relief. The current neuraxial techniques are the gold standard for adequately relieving labor pain and, when used correctly in practice, for providing safety for the mother and fetus. Systemic opioids, including meperidine (pethidine), fentanyl, and more recently remifentanil, are used to avoid or delay neuraxial analgesia or when the latter is contraindicated. The non-drug methods for labor pain relief include relaxation and respiratory maneuvers, prenatal education programs, transcutaneous electrical nerve stimulation, acupressure, aromatherapy, and hypnosis. There are a number of indications and contraindications to each analgesia technique that requires a differential approach and must be chosen individually for each parturient woman, by taking into account her somatic status. The dural puncture epidural (DPE) technique, a novel method of labor analgesia, has recently gained popularity following a basic study comparing standard epidural analgesia and combined spinal epidural analgesia with DPE for labor pain relief. Compared to the traditional landmark-based approach, neuraxial ultrasound is associated with fewer technical failures and traumatic placements, as well as with the fewer insertions and redirections of an epidural needle. Patient-controlled epidural analgesia (PCEA) with a programmed intermittent epidural bolus (PIEB) is a preferred supportive therapy option that provides effective patient-centered labor analgesia. To date, there is no ideal labor pain relief method that can be applied to all clinical cases.
Conclusion: The current neuraxial techniques are the gold standard for optimal provision of labor pain relief and, when used correctly, are associated with maternal and fetal/neonatal safety. The use of neuraxial techniques, such as combined spinal epidural anesthesia or DPE may have advantages over the standard epidural analgesia. It is necessary to further investigate labor pain relief options with the safest methods and drugs.

Authors’ contributions: Pyregov A.V., Pismensky S.V., Zolotareva L.S., Baev O.R., Abdulaev A.M., Darbinyan V.O. – development of the design of the investigation, obtaining the data available in the literature and those to be analyzed, review of publications on the topic of the article, writing the text of the manuscript.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Pismensky S.V., Zolotareva L.S., Baev O.R., Abdulaev A.M., Darbinyan V.O., Pyregov A.V. Current state of anesthesia for labor.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (2): 26-31 (in Russian)


neuraxial anesthesia techniques
epidural analgesia
dural puncture epidural techniques
combined spinal epidural anesthesia
labor activity


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Received 16.11.2022

Accepted 13.01.2023

About the Authors

Sergey V. Pismensky, doctor at the Department of Anesthesiology and Resuscitation, Assistant at the Department of Anesthesiology and Resuscitation, Academician
V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495)438-77-77,, 117997, Russia, Moscow, Akademika Oparina str., 4.
Lyubov S. Zolotareva, PhD, Junior Researcher, Department of Pediatric Reconstructive and Plastic Surgery, Research Institute of Clinical Surgery, Pirogov RNRMU,
Ministry of Health of Russia, Filatov Children's City Clinical Hospital No. 13niversity, +7(903)545-19-78, e-mail:,, SPIN: 4553-0869, 123001, Russia, Moscow, Sadovaya-Kudrinskaya str., 15, bldg. 3.
Oleg R. Baev, Dr. Med. Sci., Professor, Head of the 1st Maternity Department, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495)438-11-88,, 117997, Russia, Moscow, Akademika Oparina str., 4.
Akhmed M. Abdulaev, resident of the Department of Anesthesiology and Resuscitation, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
+7(495)438-77-77,, 117997, Russia, Moscow, Akademika Oparina str., 4.
Volodya O. Darbinyan, resident of the Department of Anesthesiology and Resuscitation, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
+7(495)438-77-77,,, 117997, Russia, Moscow, Akademika Oparina str., 4.
Alexey V. Pyregov, Dr. Med. Sci., Professor, Head of the Department of Аnesthesiology and Resuscitation, Director of the Institute of Аnesthesiology of Resuscitation and Transfusiology, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495)438-77-77,, 117997, Russia, Moscow, Akademika Oparina str., 4.

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