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What options are available to the mother for labor analgesia?
Many techniques have been utilized to reduce the perception of pain during labor. In addition to systemic medications, inhalation agents, and regional anesthesia, hypnosis, psychoprophylaxis, acupuncture, and transcuta-neous electrical nerve stimulation (TENS) have been used.
Systemic opioids can be used to attenuate labor pains; however, low-dose opioids do not completely eliminate the pain. Meperidine is the most frequently used opioid for labor analgesia. Intravenous meperidine peaks in about 10 minutes and lasts approximately 3â€“4 hours. Neonates born within 2 hours of maternal administration of meperidine are at risk for respiratory depression. Morphine is rarely used during labor because neonates are extremely sensitive to its respiratory depressant effect. Remifentanil can be used as part of patient-controlled analgesia (PCA) during labor. The advantage of remifentanil is that its onset and duration of action are shorter than those of meperidine. However, it is also more potent and close maternal respira-tory monitoring is required, preferably with pulse oximetry.
The goal of inhalation analgesia during labor is to achieve analgesia without depressing airway reflexes. Typically, at the beginning of each contraction the mother, using a hand-held device, self-administers the anesthetic agents. The most commonly used vapors are nitrous oxide and enflurane. Although this technique provides moder-ately good analgesia, it is not commonly used because of the risk of maternal aspiration with deep levels of anesthesia.
Regional anesthesia, epidural or combined spinal-epidural, have become popular modalities for labor analge-sia because of their safety and efficacy profile.
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