Analgesia and anaesthesia in labour

Analgesia in labour is often required for humanitarian and medical reasons. Neuraxial (epidural or intrathecal) analgesia is the only technique capable of producing complete relief from pain. Analgesia in labour is influenced by parity, duration of labour, experience in previous labour, and the induction (not spontaneous onset) of labour. Low-dose local anaesthetic and opioid solutions (e.g. bupivacaine 0.065–0.10% with fentanyl 2 μg/ml) can achieve excellent analgesia with good preservation of motor function. Patient-controlled analgesia using the ultra-short-acting opioid remifentanil may offer an alternative if neuraxial analgesia is contraindicated.Maternal mortality associated with anaesthesia has fallen dramatically in the past 50 years due to the increased use of regional anaesthesia for obstetric surgery, together with the more focused training of anaesthetists.