Epidural analgesia for labour and delivery. Current evidence.
Currently, evidence-based medicine indicates that epidural analgesia (EA) labor is not associated with cesarean and instrumental delivery for dystocia. This evidence was obtained from clinical investigations of variability in clinical labor management. An optimized balance between anesthesiological and obstetric practice is vitally important for securing spontaneous delivery. The total dose of local anesthetic for EA may be associated with operative delivery when there is a lack of obstetric care standardization and co-interventions reducing unintended EA effects. Furthermore, combining local anesthetic low dose and opioid low dose may produce a new balance with obstetric management. Physiological and pharmacological knowledge together with recent clinical findings suggest that combined opioid-local anesthetic low dose EA causes minimal negative effects on labor progress and is effective and safe in terms of maternal and neonatal outcome. Internal communication between obstetricians and anesthesiologists is essential for optimizing EA labor management. Processes of health care quality management, such as medical audit and peer review, should be routinely practiced to reach this goal.
Operative Unit of Anesthesia and Resuscitation II, Polyclinic Hospital, Bari, Italy. massimo.marucci@tin.it
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D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011786:Quality Control