Maintenance of neuraxial block in labor analgesia

SummaryNeuraxial analgesia for the treatment of labor pain has proven to be efficacious and safe over the past few decades. At present, several new strategies are being developed to further enhance pain relief and maternal satisfaction of our parturients in the hope of enabling them to have a more fulfilling birth experience. These include the use of patient-controlled epidural analgesia, the interest in the use of intermittent boluses as opposed to a continuous infusion for the administration of epidural local anesthetics, as well as the introduction of novel computer-integrated drug-delivery systems. These recent developments have helped in providing more efficacious analgesia and greater maternal satisfaction along with reduced local anesthetic consumption for our laboring patients. They have also contributed significantly in reducing physician workload by reducing the incidence of breakthrough pain. This review will focus on updates and recent advances in providing labor epidural analgesia over the past few years and discuss their advantages and various controversies. We will also review current literature on the use of adjuvants such as clonidine and neostigmine and their role in maintaining neuraxial block in labor.