Conclusion
While there are no “new” options for relieving labour pain, our understanding of the currently available techniques continues to evolve. We are fortunate that we currently have the ability to relieve labour pain safely. Time and careful clinical and laboratory studies will improve our understanding of the strengths and limitations of the currently available approaches to labour analgesia and allow us to refine and improve continuously the care we can offer these women.
Conclusion
Bien qu’il n’y ait pas de «nouvelles» possibilités pour soulager la douleur durant le travail, notre compréhension des tech niques couramment disponibles continue à s’améliorer. Nous sommes chanceux de pouvoir actuellement soulager la douleur du travail de façon sécuritaire. Le temps ainsi que des études en clinique et en laboratoire, menées soigneusement, vont améliorer notre connaissance des forces et des limites des approches actuellement disponibles dans l’analgésie du travail pour nous permettre d’améliorer et de raffiner les soins que nous pouvons offrir à toutes ces femmes.
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References
Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labour support from labour attendant for primiparous women: a metaanalysis. Obstet Gynecol 1996; 88: 739–44.
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continous emotional support during labour in a US hospital. A randomized controlled trial. JAMA 1991; 265: 2197–201.
Olofason C, Ekblom A, Ekman-Orderberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidine in labour pain. Br J Obstet Gynaecol 1996; 103: 968–72.
Hawkins JL, Gibbs CP, Orleans M, Martin-Salvaj G, Beaty B. Obstetric anesthesia workforce survey: 1981 versus 1992. (Abstract) Anesthesiology 1997; 87: 135–43.
Podlas J, Breland BD. Patient-controlled analgesia with nalbuphine during labour. Obstet Gynecol 1987; 70: 202–4.
Frank M, McAteer EJ, Cattermole R, Loughnan B, Stafford LB, Hitchcock AM. Nalbuphine for obstetric analgesia. A comparison of nalbuphine with pethidine for pain relief in labour when adminsitered by patient-controlled analgesia (PCA). Anaesthesia 1987; 42: 697–703.
Carstoniu J, Levytam S, Norman P, Daley D, Katz J, Sandler AN. Nitrous oxide in early labour. Safety and analgesic efficacy assessed by a double-blind, placebocontrolled study. Anesthesiology 1994; 80: 30–5.
Sharma SK, Sidawi JE, Ramin SM, Lucas MJ, Leveno KJ, Cunningham FG. Cesarean delivery. A randomized trial of epidural versus patient controlled meperidine analgesia during labour. Anesthesiology 1997; 87: 486–94.
Garner KG, Smith CV, Rayburn WF. Maternal respiratory arrest associated with intravenous fentanyl use during labour. A case report. J Reprod Med 1994; 39: 818–20.
Parker RK. Influence of labour epidural management on outome in obstetrics. (Abstract) Reg Anesth 1992; 17: S31.
Naulty JS, March MG, Leavitt KL, Smith R, Urso PR. Effect of changes in labour analgesic practice on labour outcome. Anesthesiology 1992; 77: A979.
Stoddart AP, Nicholson KEA, Popham PA. Low dose bupivacaine/fentanyl epidural infusions in labour and mode of delivery. Anaesthesia 1994; 49: 1087–90.
Chestnut DH, Laszewski LJ, Pollack KL, Bates JN, Manago NK, Choi WW. Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labour. Anesthesiology 1990; 72: 613–8.
Vertommen JD, Vandermeulen E, Van Aken H, et al. The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labour and on the incidence of instrumental deliveries. Anesthesiology 1991; 74: 809–14.
Chestnut DH, Vandewalker GE, Owen CL, Bates JN, Choi WW. The influence of continuous epidural bupivacaine analgesia on the second stage of labour and method of delivery in nulliparous women. Anesthesiology 1987; 66: 774–80.
Reynolds F. Does the left hand know what the right hand is doing? An appaisal of single enantiomer local anaesthetics. Int J Obstet Anesth 1997; 6257: 269.
Owen MD, D’Angelo R, Gemncher JC, et al. 0.125% ropivacaine is not superior to 0.125% bupivacaine for labour analgesia utilizing PCEA. Anesthesiology 1997; 87: A907.
Peres da Silva E, Abboud TK, Lee J. Comparison of 0.07% ropivacaine plus sulentanil and 0.07% bupivacaine plus suLentanil for epidural anesthesia during labour and delivery. Anesthesiology 1997; 87: A882.
Lyons G, Columb M, Hawthorne L, Dresner M. Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent. Br J Anaesth 1997; 78: 493–7.
Polley LS,Columb MO,Wagner DS,Naughton NN,Youn PY,Thessen CC. Dose dependent reduction of the minimum local analgesic concentration (MLAC) of bupivacaine by sulentanil for epidural analgesia in labour. Anesthesiology 1998; (in press).
D’Angelo R, Anderson MT, Philip J, Eisenach JC. Intrathecal sufentanil compared to epidural bupivacaine for labour analgesia. Anesthesiology 1994; 80: 1209–15.
Collis RE, Davies DWL, Aveling W. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet 1995; 345: 1413–6.
Norris MC, Grieco WM, Borkowski M, et al. Complications of labour analgesia: epidural versus combined spinal epidural techniques. Anesth Analg 1994; 79: 529–37.
Leighton BL, Arkoosh VA, Huffnagle S, Huffnagle HJ, Kinsella SM, Norris MC. The dermatomal spread of epidural bupivacaine with and without prior intrathecal sutentanil. Anesth Analg 1996; 83: 526–9.
Swenson JD, Wisniewski M, McJames S, Ashburn MA, Pace NL. The effect of prior aural puncture on asternal cerebrospinal fluid morphine concentrations in sheep after administration of lumbar epidural morphine. Anesth Analg 1996; 83: 523–5.
Hays RL, Palmer CM. Respiratory depression after intrathecal sufentanil during labour. Anesthesiology 1994; 81: 511–2.
Greenhalgh CA. Respiratory arrest in a parturient following intrathecal injection of sutentanil and bupivacaine. Anaesthesia 1996; 51: 173–5.
Ferouz F, Norris MC, Leighton BL. Respiratory arrest after intrathecal sutentanil. Anesth Analg 1997; 85: 1088–90.
Ferouz F, Norris MC, Arkoosh VA, Leighton BL, Boxer LM, Corba RJ. Baricity, needle direction, and intrathecal sufentanil labour analgesia. Anesthesiology 1997; 86: 592–8.
Lu JK, Schafer PG, Gardner TL, et al. The doseresponse pharmacology of intrathecal sutentanil in female volunteers. (Abstract) Anesth Analg 1997; 85: 372–8.
Norris MC, Ryan C, Fogel S, Holtmann B. Intrathecal sufentanil increases end-tidal C02 in labouring women. Anesthesiology 1997; 87: A885.
Jaffee JB, Drease GE, Kelly T, Newman LM. Severe respiratory depression in the obstetric patient after intrathecal meperidine or sufentanil. Int J Obstet Anesth 1997; 6: 182–4.
Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labour: a cause of fetal bradycardia? Anesthesiology 1994; 81: 1083.
Eberle RL, Norris MC, Mallozzi Eberle A, Naulty JS, Arkoosh VA. The effect of maternal position on fetal heart rate during epidural or intrathecal analgesia for labour. Anesthesiology 1995; 83: A944.
Nielsen PE, Erickson JR, Abouleish EI, Perriatt S, Sheppard C. Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labour analgesia: incidence and clinical signficance. Anesth Analg 1996; 83: 742–6.
Steiger RM, Nagoette MP. Effect of uterine contractility and maternal hypotension on prolonged decelerations after bupivacaine epidural anesthesia. Am J Obstet Gynecol 1990; 163: 808–12.
Friedlander JD, Fox HE, Cain CF, Dominquez CL, Smiley RM. Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labour. Reg Anesth 1997; 22: 378–81.
Roerig SC, Fujimoto JM. Multiplicative interaction between intrathecally and intracerebroventricularly administered mu; opioid agonists but limited interactions between delta and kappa agonists for antinociception in mice. J Pharmacol Exp Ther 1989; 249: 762–8.
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Norris, M.C. Labour analgesia: what are the (new) options?. Can J Anaesth 45 (Suppl 1), R138–R148 (1998). https://doi.org/10.1007/BF03019214
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DOI: https://doi.org/10.1007/BF03019214