Alternative Techniques For Labor Analgesia - UTMB Health

Kelly g. elterman, mdAssistant professorUniversity of texas medical branch
Alternative Techniques For Labor Analgesia
Introduction
Central neuraxial techniques have been mainstay of labor analgesiaNot an option for ALL patientsAlternatives include:Non-pharmacologic Labor AnalgesiaNatural childbirth (no analgesia)“Alternative” techniquesIntravenous Labor AnalgesicsNitrous oxide
Non-Pharmacologic Labor Analgesia Examples
Relaxation, massage therapyHypnotherapyAromatherapyMusicAcupunctureWater immersion
Non-Pharmacologic Labor Analgesia
Goals are to improve coping, not lessen painClosely tied to maternal satifactionOften related to cultural/regional acceptancePersonal support has been shown most beneficialImproved maternal, neonatal, analgesic, satisfaction outcomes
Arendt K. Clin Perinatal. 2013.
Non-Pharmacologic Labor Analgesia
Most have little riskExcept water immesion in second stageOften compatible with regional techniquesExcept water immersionStudieslacking, efficacy difficult todetermineSome data show that acupuncture, acupressure, TENS, relaxation/massage provide modest relief
Arendt K. Clin Perinatal. 2013.Committee Opin 594. Obstet Gynecol. 2014.
Intravenous Labor Analgesics
OpioidsBolus vs Patient-Controlled AnalgesiaEquipment/staffingChoice of agentNubainFentanylMeperidineRemifentanilNon-opioid AnalgesicsAcetaminophenParacetamolDexmedetomidine
Abd-El-Maeboud KH, et. al. J Obstet Gynaecol Res. 2014.Evron S et. al. Curr Opin Anaesthesiol. 2007.
Intravenous Labor Analgesics
OpioidsNubain frequently administered as bolusFentanyl PCA commonRemifentanil PCA gaining popularityQuick on/offDifficulty timing bolus increases risksStrict monitoring necessaryNon-opioid AnalgesicsAcetaminophen/ParacetamolDexmedetomidine
Abd-El-Maeboud KH, et. al. J Obstet Gynaecol Res. 2014.Evron S et. al. Curr Opin Anaesthesiol. 2007.Marr et. al. Anaesthesia. 2013.Liu et. al. Anesth Analg. 2014.Stocki et. al. Anesth Analg.2014.Birnbach D, Ranasinghe J. Anesth Analg. 2014.
Nitrous Oxide
Frequently used in Europe, gaining popularity in USColorless, sweet-smelling gasNMDA receptor antagonistAdministered with oxygen, blender device or pre-mixedPatient can self-administer
King T, Wong C.AnesthAnalg. 2014.Likiset. al.AnesthAnalg. 2014.
Nitrous Oxide
AdvantagesEasy to administerAvoidsneuraxialtechniqueAnxiolytic effectDisadvantagesAnalgesic effects inferior toneuraxialtechniqueSafety and efficacy largelyunknownGood studies lackingExisting studies difficult to analyze
King T, Wong C.AnesthAnalg. 2014.Likiset. al.AnesthAnalg. 2014.
Summary
Multiple analgesic modalities existAll inferior toneuraxialtechniqueMulti-modal approach is bestPersonal support is key for patients
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