Comparative assessment of neuraxial labor analgesia techniques

Objective. To determine the method of choice for labor analgesia, by comparatively evaluating the efficiency and safety of ultra-low dose spinal, epidural, and paravertebral analgesia. Subjects and methods. The investigation involved 4 groups: 1) 40 patients whose labor anesthesia was achieved by epidural analgesia; 2) 40parturients whose labor anesthesia was attained by ultra-low dose spinal analgesia; 3) 40parturients whose labor anesthesia was done by paravertebral analgesia; 4) a control group of 40patients who received no analgesia. Central hemodynamic indicators, such as heart rate, blood pressure, and mean blood pressure, were monitored. The degree of motor block was measured using the Bromage scale. The dynamics of womb mouth opening and the duration of the first and second stages of labor were estimated. Complications and negative effects of anesthesia were also recorded; the effect of maternal analgesia on the fetus was evaluated. Results. Labor analgesia can stabilize hemodynamic changes in a parturient and substantially declines the number of labor abnormalities. Neuraxial techniques produced a high level of analgesia. Epidural analgesia showed its high efficiency and safety; however, the duration of the pushing phase of labor was significantly longer than that in the other groups. Ultra-low dose spinal analgesia also provided a sufficient analgesic effect in the first stage of labor. However, compared with the other methods, its short-term effect did not always ensure effective anesthesia of the second stage of labor. The advantages of paravertebral analgesia, such as a significant acceleration in cervical opening, and a reduction in labor time were generally revealed. There were no cases of motor block assessed by a Bromage score of 2 during paravertebral analgesia, while there were single cases with a score of 1 and 2 in the epidural and ultra-low dose spinal analgesia groups. Unlike other neuraxial labor analgesia techniques, paravertebral block did not cause low blood pressure. Conclusion. Neuraxial procedures provide an adequate level of analgesia, are able to eliminate labor abnormalities, and do not adversely affect the fetal status. All the presented analgesia techniques are used in obstetric anesthesiology. Knowledge of their features allows the choice of an anesthetic technique for spontaneous labor depending on the obstetric situation.

epidural analgesia, ultra-low dose spinal analgesia, paravertebral analgesia