Anaesthetist provided labour analgesia

SummaryRegional analgesia (epidural and spinal) can provide good analgesia with minimal sedation for labour but has disadvantages associated with its side effects and complications. It may also influence the mode of delivery by increasing the risk of instrumental deliveries. This review will outline and discuss developments in current practice in both epidural and spinal regional techniques including the choice of drugs used (local anaesthetics and opioids), route of administration (epidural, intrathecal and combinations of both), and how analgesia is maintained (continuous infusion, intermittent boluses, and patient controlled).Regional analgesia is not suitable for all women. Systemic administration of opioids remains a widely used alternative. This review will also discuss developments in the use of intravenous patient-controlled administration of opioids and will particularly focus on the use of the ultra-short acting opioid remifentanil for labour analgesia.