Neuraxial labor analgesia: a literature review: a letter to the editor

I read the article entitled “Neuraxial labor analgesia: a literature review” with great interest.¹ Labor is one of the most memorable events in every woman’s life, but labor pain can make it one of their most unpleasant experiences. For this reason, in recent decades many pregnant women have tended to cesarean section. Fortunately, though, fighting labor pain by new modalities provided by the anesthesia team have opened up new hopes for mothers. However, the complexity of the best methods, such as continuous spinal epidural analgesia,^1,2 does not allow all mothers to enjoy the same way. On the other hand, as pain per se is a subjective matter, the satisfaction of a mother from applied pain reduction method is strongly influenced by factors such as her socioeconomic level.³ In rural population and in low income territories, resource constraints may force anesthesiologists to choose simpler and cheaper modalities to control labor pain. The single shot intrathecal opioid may be the best method to fit this situation. This method may not completely eliminate pain but can significantly reduce the pain level and make it more tolerable. In other words, we can offer a pain-reduced labor instead of a painless one. Half a loaf is better than none for a hungry man! Additionally, some intrathecal additives, such as midazolam, and minimal concertation of local anesthetics, such as bupivacaine, can strengthen it.^4,5 Obviously, opioid dosage and the timing of the procedure is of particular importance to avoid unwanted events and to get the most benefits.

References

• ¹
  Aragao FF, Aragao PW, Martins CA, et al. Neuraxial labor analgesia: a literature review. Rev Bras Anestesiol. 2019;69:291-8.
• ²
  Braga AFA, Carvalho VH, Braga F, et al. Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block. Rev Bras Anestesiol. 2019;69:7-12.
• ³
  Darnall BD, Carr DB, Schatman ME. Pain psychology and the biopsychosocial model of pain treatment: ethical imperatives and social responsibility. Pain Med. 2017;18:1413-5.
• ⁴
  Salimi A, Aminnejad R, Safari F, et al. Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil. Korean J Anesthesiol. 2014;66:204-9.
• ⁵
  Mousavi S, Aminnejad R. The effect of addition of intrathecal sufentanil to hyperbaric bupivacaine in cesarean section-a prospective randomized study: a letter to the editor. Anaesth Pain Intensive Care. 2019;23:105.

Publication Dates

• Publication in this collection
  01 July 2020
• Date of issue
  Jan-Feb 2020

History

• Received
  5 July 2019