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Labour analgesia: choice of local anaesthetics 

Labour analgesia: choice of local anaesthetics
Labour analgesia: choice of local anaesthetics

Giorgio Capogna

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date: 28 November 2020

In this chapter, the rationale for the choice of commonly used local anaesthetics—racemic bupivacaine, ropivacaine, and levobupivacaine—is reviewed, particularly with respect to their potency and differential block. Epidural and spinal dosing for labour analgesia and the role of ‘up–down’ studies to determine the minimum local anaesthetic concentration (MLAC) for labour analgesia is explained. Applying the MLAC model has enabled clinical comparisons at equipotent concentrations and doses. It has also quantified what contribution opioids have on the overall effectiveness of the analgesic mixture, provided a means of optimizing combinations of local anaesthetic–opioid solutions, examined the effect of inter-individual and obstetric variables on local anaesthetic potency, and provided a pharmacological-based rationale for analgesia solutions used for labour analgesia.

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