title: Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review.
abstract: OBJECTIVE
  In modern obstetrics, different pharmacological and non-pharmacological options allow to obtain pain relief during labour, one of the most important goals in women satisfaction about medical care. The aim of this review is to compare all the analgesia administration schemes in terms of effectiveness in pain relief, length of labour, mode of delivery, side effects and neonatal outcomes.
  
  
  METHODS
  A systematic literature search was conducted in electronic databases in the interval time between January 1999 and March 2013. Key search terms included: “labour analgesia”, “epidural anaesthesia during labour” (excluding anaesthesia for Caesarean section), “epidural analgesia and labour outcome” and “intra-thecal analgesia”.
  
  
  RESULTS
  10,331 patients were analysed: 5,578 patients underwent Epidural-Analgesia, 259 patients spinal analgesia, 2,724 combined spinal epidural analgesia, 322 continuous epidural infusion (CEI), 168 intermittent epidural bolus, 684 patient-controlled infusion epidural analgesia and 152 intra-venous patient-controlled epidural analgesia. We also considered 341 women who underwent patient-controlled infusion epidural analgesia in association with CEI and 103 patients who underwent patient-controlled infusion epidural analgesia in association with automatic mandatory bolus.
  
  
  CONCLUSIONS
  No significant differences occurred among all the available administration schemes of neuraxial analgesia. In absence of obstetrical contraindication, neuraxial analgesia has to be considered as the gold standard in obtaining maternal pain relief during labour. The options available in the administration of analgesia should be known and evaluated together by both gynaecologists and anaesthesiologists to choose the best personalized scheme and obtain the best women satisfaction. Since it is difficult to identify comparable circumstances during labour, it is complicate to standardize drugs schemes and their combinations.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.forename: Simone
authors.initials: S
authors.lastname: Fagherazzi
authors.forename: Laura
authors.initials: L
authors.lastname: Lamparelli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ancona
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D007743:Labor, Obstetric; D010147:Pain Measurement; D010549:Personal Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome