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Obstetrics and Gynegology2023№2
Current state of anesthesia for...

Current state of anesthesia for labor

DOI
https://dx.doi.org/10.18565/aig.2022.273

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)
https://dx.doi.org/10.18565/aig.2022.273

Keywords

neuraxial anesthesia techniques
epidural analgesia
dural puncture epidural techniques
combined spinal epidural anesthesia
labor activity
Full text (in Russian)

References

  1. Динамика изменения численности населения Земли в 2022 году. Доступно по: https://countrymeters.info/ru Активна на: 20.04.2022. [Dynamics of changes in the population of the Earth in 2022. Available at:https://countrymeters.info/ru Accessed 04.20.2022. (in Russian)].
  2. Wang E. Requests for cesarean deliveries: the politics of labor pain and pain relief in Shanghai, China. Soc. Sci. Med. 2017;1 73: 1-8.
  3. Gunaydin B., Erel S. How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option. J. Anesth. 2019; 33(1): 125-30.https://dx.doi.org/10.1007/s00540-018-2564-y.
  4. Gómez-Ríos M.Á., Codesido-Barreiro P., Seco-Vilariño C., Calvín-Lamas M., Curt-Nuño F., Nieto-Serradilla L. et al. Wound infusion of 0.35% levobupivacaine reduces mechanical secondary hyperalgesia and opioid consumption after cesarean delivery: a prospective, randomized, triple-blind, placebo-controlled trial. Anesth. Analg. 2022; 134(4):791-801. https://dx.doi.org/10.1213/ANE.0000000000005917.
  5. McCaffery M., Pasero C. Pain: a clinical manual. St Louis, MO: Mosby; 1999.
  6. Bartley E.J., Fillingim R.B. Sex differences in pain: a brief review of clinical and experimental findings. Br. J. Anaesth. 2013; 111(1): 52-8.https://dx.doi.org/10.1093/bja/aet127.
  7. Debiec J., Conell-Price J., Evansmith J., Shafer S.L., Flood P. Mathematical modeling of the pain and progress of the first stage of nulliparous labor. Anesthesiology. 2009; 111(5): 1093-110. https://dx.doi.org/10.1097/ALN.0b013e3181ba3f28.
  8. Lang A., Sorell J., Rodgers C., Lebeck M.M. Anxiety sensitivity as a predictor of labor pain. Eur. J. Pain. 2006; 10(3): 263-70. https://dx.doi.org/10.1016/j.ejpain.2005.05.001.
  9. Drissi I., Woods W.A., Woods C.G. Understanding the genetic basis of congenital insensitivity to pain. Br. Med. Bull. 2020; 133(1): 65-78.https://dx.doi.org/10.1093/bmb/ldaa003.
  10. Потапов А.Л., Земскова Д.В., Иванова Т.И., Хорохорина В.А., Шегай П.В.,Иванов С.А., Каприн А.Д. Оценка влияния однонуклеотидного полиморфизма val158met гена катехол-О-метилтрансферазы (СОМТ) на эффективность спинальной аналгезии в 1 сутки после лапароскопических операций по поводу колоректального рака (пилотное исследование). Общая реаниматология. 2019; 15(6): 4-10. [Potapov A.L., Zemskova D.V., Ivanova T.I., Khorokhorina V.A., Shegay P.V., Ivanov S.A., Kaprin A.D. Evaluation of the effect of single nucleotide polymorphism val158met of the catechol-O-methyltransferase (COMT) gene on the effectiveness of spinal analgesia on day 1 after laparoscopic surgery for colorectal cancer (pilot study). General Reanimatology. 2019; 15(6): 4-10.(in Russian)].
  11. Landau R., Cahana A., Smiley R.M., Antonarakis S.E., Blouin J.L. Genetic variability of mu-opioid receptor in an obstetric population. Anesthesiology. 2004; 100(4): 1030-3. https://dx.doi.org/10.1097/00000542-200404000-00042.
  12. Адамян Л.В., Артымук Н.В., Белокриницкая Т.Е., Куликов А.В., Овезв А.М.,Петрухин В.А., Проценко Д.Н., Упрямова Е.Ю., Филиппов О.С., Шифман Е.М. Нейроаксиальные методы обезболивания родов. Клинические рекомендации. Анестезиология и реаниматология. 2018; 63(5): 99-110. [Adamyan L.V., Artymuk N.V., Belokrinitskaya T.E., Kulikov A.V., Ovezv A.M., Petrukhin V.A., Protsenko D.N., Upryamova E.Yu., Filippov O.S., Shifman E.M. Neuroxial methods of labor analgesia. Clinical guidelines. Russian Journal of Anaesthesiology and Reanimatology. 2018; 63(5): 99-110. (in Russian)]. https://dx.doi.org/10.17116/anaesthesiology201805199.
  13. Чернуха Е.А., Комисарова Л.М., Байбарина Е.Н., Пырегов А.В., Петров С.В., Катюхина Е.Г. Течение послеоперационного периода и периода адаптации новорожденных в зависимости от вида обезболивания при операции кесарева сечения. Акушерство и гинекология. 2003; 3: 12-5. [Chernukha E.A., Komisarova L.M., Baibarina E.N., Pyregov A.V., Petrov S.V., Katyukhina E.G. The course of the postoperative period and the period of adaptation of newborns depending on the type of anesthesia during cesarean section. Obstetrics and Gynecology. 2003; (3): 12-5. (in Russian)].
  14. Упрямова Е.Ю., Шифман Е.М., Овезов А.М., Новикова С.В., Ельчанинова А.Г., Чаплыгина О.В. Влияние методов обезболивания самопроизвольных родов на организм матери и плода. Альманах клинической медицины. 2018; 46(2): 137-45. [Upryamova E.Yu., Shifman E.M., Ovezov A.M., Novikova S.V., Elchaninova A.G., Chaplygina O.V. Influence of methods of anesthesia of spontaneous labor on the body mother and fetus. Almanac of Clinical Medicine. 2018; 46(2): 137-45. (in Russian)].
  15. Ronel I., Weiniger C.F. A broadening choice for labor analgesia: remifentanil on the a la carte menu. Int. J. Obstet. Anesth. 2019; 39: 1-6. https://dx.doi.org/10.1016/j.ijoa.2019.06.005.
  16. Smith C.A., Collins C.T., Levett K.M., Armour M., Dahlen H.G., Tan A.L., Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst. Rev. 2020; 2(2): CD009232. https://dx.doi.org/10.1002/14651858.CD009232.pub2.
  17. Amru D.E., Umiyah A., Yastirin P.A., Susanti N.Y., Ningsih D.A. Effect of deep breathing techniques on intensity of labor pain in the active phase. Int. J. Soc. Sci. World (TIJOSSW). 2021; 3(2): 359-64. https://dx.doi.org/10.5281/zenodo.5808532.
  18. Uçar T., Golbasi Z. Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process. J. Psychosom. Obstet. Gynaecol. 2019; 40(2): 146-55. https://dx.doi.org/10.1080/0167482X.2018.1453800.
  19. Dias N.T., Santos P.R., Cândido T.A., Pinto R.M.C., Resende A.P.M., Pereira-Baldon V.S. Effects of the addition of transcutaneous electrical stimulation to non-pharmacological measures in labor pain: study protocol for a randomized controlled trial. Trials. 2022; 23(1): 44. https://dx.doi.org/10.1186/s13063-021-05969-0.
  20. Feldman E. Labor, pain management, and acupuncture: a cochrane review. Integrative Medicine Alert. 2020; 23(9).
  21. Liao C.C., Lan S.H., Yen Y.Y., Hsieh Y.P., Lan S.J. Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis. J. Obstet. Gynaecol. 2021; 41(1): 21-31.https://dx.doi.org/10.1080/01443615.2019.1673707.
  22. Неймарк М.И., Иванова О.С. Обезболивание родов. Современный взгляд. Регионарная анестезия и лечение острой боли. 2017; 11(3): 150-6. [Nejmark M.I., Ivanova O.S. Analgesia in labour. Modern view. Regional Anesthesia and Acute Pain Management, Russian journal. 2017; 11(3): 150-6. (in Russian)]. https://dx.doi.org/10.18821/1993-6508-2017-11-3-150-156.
  23. Hu Y., Lu H., Huang J., Zang Y. Efficacy and safety of non-pharmacological interventions for labour pain management: a systematic review and Bayesian network meta-analysis. J. Clin. Nurs. 2021; 30(23-24): 3398-414.https://dx.doi,org/10.1111/jocn.15865.
  24. WHO recommendations. Intrapartum care for a positive childbirth experience. Geneva: WHO; 2018.
  25. Баев О.Р., Козлова О.А., Рубцова С.В., Румянцева В.П., Пырегов А.В. Влияние эпидуральной аналгезии на продолжительность родов, частоту слабости родовой деятельности и кесарево сечения. Акушерство и гинекология. 2014; 6: 41-6. [Baev O.R., Kozlova O.A., Rubtsova S.V., Rumyantseva V.P., Pyregov A.V. The effect of epidural analgesia on the duration of labor, the frequency of weakness of labor and caesarean section. Obstetrics and Gynecology. 2014; (6): 41-6. (in Russian)].
  26. Elsharkawy H., Sonny A., Chin K.J. Localization of epidural space: a review of available technologies. J Anaesthesiol. Clin. Pharmacol. 2017; 33(1): 16-27. https://dx.doi.org/10.4103/0970-9185.202184.
  27. Nanji J.A., Carvalho B. Pain management during labor and vaginal birth. Best Pract. Res. Clin. Obstet. Gynaecol. 2020; 67: 100-12.https://dx.doi,org/10.1016/j.bpobgyn.2020.03.002.
  28. Simmons S.W., Taghizadeh N., Dennis A.T., Hughes D., Cyna A.M. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst. Rev. 2012; (10): CD003401. https://dx.doi.org/10.1002/14651858.CD003401.pub3.
  29. Gambling D.R., Yu P., Cole C., McMorland G.H., Palmer L. A comparative study of patient controlled epidural analgesia (PCEA) and continuous infusion epidural analgesia (CIEA) during labour. Can. J. Anaesth. 1988; 35: 249-54.
  30. Heesen M., Van de Velde M., Klöhr S., Lehberger J., Rossaint R., Straube S. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia. 2014; 69(1): 64-71.https://dx.doi.org/10.1111/anae.12456.
  31. Booth J.M., Pan J.C., Ross V.H., Russell G.B., Harris L.C., Pan P.H. Combined spinal epidural technique for labor analgesia does not delay recognition of epidural catheter failures: a single-center retrospective cohort survival analysis. Anesthesiology. 2016; 125(3): 516-24. https://dx.doi.org/10.1097/ALN.0000000000001222.
  32. Collis R.E., Davies D.W.L., Aveling W. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet. 1995; 345(8962): 1413-6. https://dx.doi.org/10.1016/S0140-6736(95)92602-X.
  33. Овечкин А.Ю., Пырегов А.В. Применение регионарной анестезии у пациенток с морбидным ожирением в акушерстве и гинекологии. Анестезиология и реаниматология. 2014; 59(6): 15-9. [Ovechkin A.Yu., Pyregov A.V. The use of regional anesthesia in patients with morbid obesity in obstetrics and gynecology. Anesthesiology and Resuscitation. 2014; 59(6): 15-9. (in Russian)].
  34. Chau A., Bibbo C., Huang C.C., Elterman K., Cappiello E., Robinson J., Tsen L.C. Dural puncture epidural technique (DPE) improves labor analgesia quality with fewer side effects compared with epidural and CSE techniques: a randomized clinical trial. Anesth. Analg. 2017; 124(2): 560-9. https://dx.doi.org/10.1213/ANE.0000000000001798.
  35. Боженков К.А., Шифман Е.М., Густоварова Т.А. Эпидуральная анальгезия родов: взгляд сквозь десятилетия. Сибирское медицинское обозрение. 2020; 2: 5-12. [Bozhenkov K.A., Shifman E.M., Gustovarova T.A. Epidural labor analgesia: a look through decades. Siberian Medical Review. 2020; (2): 5-12. (in Russian)].
  36. Письменский С.В., Пырегов А В., Баев О.Р., Тысячный О.В., Переварова Ю.С. Модификация комбинированной спинально-эпидуральной аналгезии родов. Акушерство и гинекология. 2020; 1: 34-9. [Pismensky S.V., Pyregov A.V., Baev O.R., Tysyachnyi O.V., Perevarova Yu.S. Modification of combined spinal-epidural analgesia in labor. Obstetrics and Gynecology. 2020; (1): 34-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1.34-39.
  37. Wilson S.H., Wolf B.J., Bingham K., Scotland Q.S., Fox J.M., Woltz E.M., Hebbar L. Labor analgesia onset with dural puncture epidural versus traditional epidural using a 26-Gauge Whitacre needle and 0.125% bupivacaine bolus: a randomized clinical trial. Anesth. Analg. 2018; 126(2): 545-51.https://dx.doi.org/10.1213/ANE.0000000000002129.
  38. Cappiello E., O’Rourke N., Segal S., Tsen L.C. A randomized trial of dural puncture epidural (DPE) technique compared with standard epidural technique for labor analgesia. Anesth. Analg. 2008; 107(5): 1646-51.https://dx.doi,org/10.1213/ane.0b013e318184ec14.
  39. Gupta D., Srirajakalisindi A., Soskin V. Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia. Middle East J. Anaesthesiol. 20130; 22(3): 309-16.
  40. Perlas A., Chaparro L.E., Chin K.J. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg. Anesth. Pain Med. 2016; 41(2): 251-60. https://dx.doi.org/10.1097/AAP.0000000000000184.
  41. Shaikh F., Brzezinski J., Alexander S., Arzola C., Carvalho J.C.A., Beyene J. et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ. 2013; 346: f1720.https://dx.doi.org/10.1136/bmj.f1720.
  42. Vallejo M.C., Phelps A.L., Singh S., Orebaugh S.L., Sah N. Ultrasound decreases the failed labor epidural rate in resident trainees. Int. J. Obstet. Anesth. 2010; 19(4): 373-8. https://ddx.oi.org/10.1016/j.ijoa.2010.04.002.
  43. Traynor A.J., Aragon M., Ghosh D., Choi R.S., Dingmann C., Tran Z.V. et al. Obstetric anesthesia workforce survey: a 30-year update. Anesth. Analg. 2016; 122(6): 1939-46. https://dx.doi.org/10.1213/ANE.0000000000001204.
  44. Chua S.M.H., Sia A.T.H. Automated intermittent epidural boluses improve analgesia induced by intratheca fentanyl during labour. Can. J. Anaesth. 2004; 51(6): 581-5. https://dx.doi.org/10.1007/BF03018402.
  45. Wong C.A., Ratliff J.T., Sullivan J.T., Scavone B.M., Toledo P., McCarthy R.J. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth. Analg. 2006; 102(3): 904-9. https://dx.doi.org/10.1213/01.ane.0000197778.57615.1a.
  46. Capogna G., Camorcia M., Stirparo S., Farcomeni A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth. Analg. 2011; 113(4): 826-31. https://dx.doi.org/10.1213/ANE.0b013e31822827b8.
  47. Sng B.L., Zeng Y., de Souza N.N.A., Leong W.L., Oh T.T., Siddiqui F.J. et al. Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour. Cochrane Database Syst. Rev. 2018; (5): CD011344.https://dx.doi.org/10.1002/14651858.CD011344.pub2.
  48. Sultan P., Murphy C., Halpern S., Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Can. J. Anaesth. 2013; 60(9): 840-54. https://dx.doi.org/10.1007/s12630-013-9981-z.
  49. Lyons G.R., Kocarev M.G., Wilson R.C., Columb M.O. A comparison of minimum local anesthetic volumes and doses of epidural bupivacaine (0.125% w/v and 0.25% w/v) for analgesia in labor. Anesth. Analg. 2007; 104(2): 412-5. https://dx.doi.org/10.1213/01.ane.0000252458.20912.ef.
  50. Boselli E., Debon R., Duflo F., Bryssine B., Allaouchiche B., Chassard D. Ropivacaine 0.15% plus sufentanil 0.5 microg/mL and ropivacaine 0.10% plus sufentanil 0.5 microg/mL are equivalent for patient-controlled epidural analgesia during labor. Anesth. Analg. 2003; 94(6): 1173-7. https://dx.doi,org/10.1213/01.ANE.0000054168.36798.4A.
  51. Nanji J.A., Carvalho B. Pain management during labor and vaginal birth. Best Pract. Res. Clin. Obstet. Gynaecol. 2020; 67: 100-12.https://dx.doi,org/10.1016/j.bpobgyn.2020.03.002.

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, smsu@mail.ru, 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: l_zolotareva@mail.ru, https://orcid.org/0000-0001-7662-8257, 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, metod_obsgyn@hotmail.com, 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, scars225@mail.ru, 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, darbinyan196@gmail.com, https://orcid.org/0000-0002-4579-0822, 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, a_pyregov@oparina4.ru, 117997, Russia, Moscow, Akademika Oparina str., 4.

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