ReviewStrategies to reduce neuraxial analgesia failure during labour

Labour neuraxial analgesia failure may lead to inadequate pain relief and patient dissatisfaction. This may occur due to difficulty in epidural placement during the initiation of, or during the maintenance of epidural analgesia. In this review, we investigate the risk factors associated with labour neuraxial analgesia failure and present the recent evidence to improve epidural space identification. Demographic and anaesthetic factors that may increase breakthrough pain are discussed. We also examine the effect of different regimens of local anaesthetic agents and analgesic adjuvants on the quality of analgesia. The use of patient controlled epidural analgesia and novel epidural delivery systems such as the role of intermittent epidural automated boluses are explored.