Canadian Journal of Anaesthesia

, Volume 39, Supplement 1, pp R18–R28 | Cite as

Analgesia methods during labour and delivery

  • Samuel C. Hughes
Refresher Course Outline


The practice of obstetric anaesthesia can be highly rewarding. The clinician prepared with an understanding of maternal-fetal physiology (obstetric requirements), systemic narcotics, and regional anaesthesia can be highly effective at relieving pain and bringing about a successful delivery. While alternative techniques should always be considered, particularly those that stress childbirth education, continuous lumbar analgesia remains the most flexible and satisfactory approach. While there is new equipment (fine needles and smaller catheters) on the horizon, it remains to be demonstrated if they can match the success and safety record of present lumbar epidural practice.


Fentanyl Bupivacaine Epidural Analgesia Sufentanil Regional Anaesthesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Analgésie pour le travail et l’accouchement


La pratique de l’anesthésie obstétricale peut être tres encourageante. Le clinicien bien préparé avec une compréhension de la physiologie foeto-maternelle, des narcotiques systémiques, et de l’anesthésie régionale sera trés habile à soulager la douleur et à amener un accouchement réussi. Même si des approches alternatives devraient toujours être prises en considération, particulièrement celles qui insistent sur l’éducation à la naissance, l’analgésie lombaire continue demeure l’approche la plus flexible et la plus satisfaisante. Même s’il y a de l’équipement nouveau (aiguilles fines et petits cathéters) à l’horizon, il faut d’abord démontrer qu’il a le même taux de succès et de sécurité que l’analgésie épidurale lombaire telle que pratiquée actuellement.


  1. 1.
    Melzack R. The myth of painless childbirth (The John J. Bonica Lecture). Pain 1984; 19: 321–7.PubMedCrossRefGoogle Scholar
  2. 2.
    DeVore J, Hughes S. Psychologic and alternative techniques for obstetric anesthesia.In: Shnider SM, Levinson G (Eds.). Anesthesia for Obstetrics, 2nd ed., Baltimore: Williams & Wilkins, 1987; 79–88.Google Scholar
  3. 3.
    Dick-Read G. Childbirth Without Fear. 2nd ed. New York: Harper & Row, 1959.Google Scholar
  4. 4.
    Lamaze F. Painless Childbirth: Psychoprophylactic Method. London: Burke, 1958.Google Scholar
  5. 5.
    Preston P, Rosen M, Hughes S, et al. Epidural anesthesia with fentanyl and lidocaine for cesarean section: maternal effects and neonatal outcome. Anesthesiology 1988; 68: 938–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Moran D, Perillo M, Bader A, Datta S. Phenylephrine in treating maternal hypotension secondary to spinal anesthesia. Anesthesiology 1989; 71: A857.CrossRefGoogle Scholar
  7. 7.
    Wright R, Shnider SM, Levinson G, Rolbin S, Parer. The effect of maternal administration of ephedrine on fetal heart rate and variability Am J Obstet Gynecol 1981; 57: 734–8.Google Scholar
  8. 8.
    Hughes S, Ward M, Levinson G, et al. Placental transfer of ephedrine does not affect neonatal outcome. Anesthesiology 1985; 63: 217–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Shnider SM, Levinson G, Ralston D. Regional anesthesia for labor and delivery.In: Shnider SM, Levinson G (Eds.). Anesthesia for Obstetrics, 2nd ed., Baltimore: Williams & Wilkins, 1987; 109–22.Google Scholar
  10. 10.
    Ostheimer G. Regional anesthesia.In: Ostheimer G (Ed.). Manual of Obstetric Anesthesia, New York: Churchill Livingstone Inc., 1984:165–220.Google Scholar
  11. 11.
    Rogers RPC, Levin J. A critical reappraisal of the bleeding time. Sem Thrombosis Hemostasis 1990; 16: 1–20.CrossRefGoogle Scholar
  12. 12.
    Roblin S, Abbott D, Musclow E, Papsin F, Lie L, Freedman J. Epidural anesthesia in pregnant patients with low platelet counts. Obstet Gynecol 1988; 71: 918–20.Google Scholar
  13. 13.
    Letsky E. Haemostasis and epidural anaesthesia. Int J Obstet Anesth 1991; 1: 51–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Biehl D. The dilemma of the epidural test dose. Can J Anaesth 1987; 34: 345–8.CrossRefGoogle Scholar
  15. 15.
    Cartwright P, McCarroll S, Antzaka C. Maternal heartrate changes with a plain epidural test dose. Anesthesiology 1986; 65: 225–8.CrossRefGoogle Scholar
  16. 16.
    Leighton B, Norris M, Sosis M, Epstein R, Chayen B, Larijani G. Limitations of epinephrine as a marker of intravascular injection in laboring women. Anesthesiology 1987; 66: 668–91.CrossRefGoogle Scholar
  17. 17.
    Leighton B, Norris M, DeSimone C, Rosko T, Gross J. The air test as a clinically useful indicator of intravenously placed epidural catheters. Anesthesiology 1990; 73:610–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Grice S, Eisenach J, Dewan D, Mandell G. Evaluation of 2-chloroprocaine as an effective intravenous test dose for epidural analgesia. Anesthesiology 1987; 67: A627.CrossRefGoogle Scholar
  19. 19.
    Chestnut D, Owen C, Brown C, Vandewalker G, Weiner C. Does labor affect the variability of maternal heart rate during induction of epidural anesthesia? Anesthesiology 1988; 68: 622–5.PubMedGoogle Scholar
  20. 20.
    Hughes S. Intraspinal opiates in obstetrics.In: Shnider SM, Levinson G (Eds). Anesthesia for Obstetrics, 2nd ed., Baltimore: Williams & Wilkins, 1987; 123–41.Google Scholar
  21. 21.
    Chestnut D. Continuous infusion epidural analgesia during labor. A randomized double-blind comparison of 0.0625% bupivacaine, 0.0003% fentanyl versus 0.125% bupivacaine. Anesthesiology 1988; 68: 754–9.PubMedGoogle Scholar
  22. 22.
    Phillips G. Continuous infusion epidural analgesia in labor. The effect of adding sufentanil to 0.125% bupivacaine. Anesth Analg 1988; 67: 462–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Leighton B, DeSimone C, Norris M, Ben-David B. Intrathecal narcotics for labor revisited: the combination of fentanyl and morphine intrathecally provides rapid onset of profound, prolonged analgesia. Anesth Analg 1989; 69: 122–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Palmer C Early respiratory depression following intrathecal fentanyl-morphine combination. Anesthesiology 1991; 74: 1153–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Rigler M, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72: 275–81.PubMedCrossRefGoogle Scholar
  26. 26.
    Sprotte G, Schedle R, Pajunk H, Pajunk H. Eine “atraumatische” Universalkanüle für einzeitige regionalanaesthesien. Regional Anaesthesia 1987; 10: 104–8.Google Scholar
  27. 27.
    Hughes S. Intraspinal narcotics for analgesia after caesarean section. Current Opinions in Anaesthesiology 1989; 2: 295–302.CrossRefGoogle Scholar
  28. 28.
    Cesarini M, Torrielli R, Lahaye F, Mene J, Cabiro C. Sprotte needle for intrathecal anaesthesia for caesarean section: incidence of postdural puncture headache. Anaesthesia 1990; 45: 656–8.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1992

Authors and Affiliations

  • Samuel C. Hughes
    • 1
  1. 1.Department of AnesthesiaUniversity of California, San Francisco, San Francisco General HospitalUSA

Personalised recommendations