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Recent Advances in Labour Analgesia
Pain of labour is said to be one of the most intense on the pain scale. Experience of labour varies among women, and even among different pregnancies in the same woman depending on various factors. Offering of analgesia to labouring women has become the standard of care across the globe. Since the earliest days when labour analgesia was initiated, multiple non pharmacological methods have been described. Different forms of exercises performed antenatally also have shown some benefit in labouring women. However pharmacological methods are more efficacious with higher chance of success compared to nonpharmacological methods. Systemic analgesics include administration of opioids and inhaled anaesthetics. Of special mention in recent times is the advantageous use of remifentanil for alleviating pain of labour. Inhaled anaesthetics are being less favoured due to their effects like amnesia. Neuraxial blockade remains to be the gold standard form of labour analgesia. Of the various methods, the most commonly followed forms include epidural analgesia and combined spinal epidural analgesia. Various new technological advances have been made to make administering analgesia via epidural easier, such as computer integrated patient controlled epidural analgesia and programmed intermittent epidural boluses which have been detailed in the review. Other newer technologies such as virtual reality are also described as newer forms of painless labour. Despite multiple options that are available, it must be borne in mind that each labouring woman and every birth is special. Hence, these options need to be tailored to suit every woman's needs during childbirth.
Labour, Pain Pathways, Analgesia, Epidural.
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