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Maintenance of neuraxial labour analgesia 

Maintenance of neuraxial labour analgesia
Maintenance of neuraxial labour analgesia

Alex Tiong Heng Sia

, Ban Leong Sng

, and Serene Leo

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date: 27 November 2020

Labour pain may be treated with epidural analgesia providing effective pain relief with no maternal sedation to allow maternal participation in the labouring process. Epidural analgesia is commonly initiated using an epidural or combined spinal–epidural technique. Most epidural maintenance regimens would include a long-acting amide anaesthetic in low concentration together with a lipophilic opioid to maximize analgesia whilst reducing motor blockade. With the advent of advanced infusion delivery systems, maintenance of epidural analgesia may be individualized through the use of patient-controlled epidural analgesia systems. Patient self-administered bolus is used as a feedback to increase local anaesthetic use when labour pain intensifies. Recent developments in pump technology and innovations have enabled novel epidural delivery systems such as automated mandatory boluses, variable frequency automated mandatory boluses, and computer integrated patient controlled epidural analgesia.

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