title: Obstetric analgesia - update 2016.
abstract: Neuraxial labor analgesia can be initiated via combined spinal-epidural (CSE) or stand-alone epidural. Pros and cons of these techniques are outlined in this review. In recent years computer-integrated patient-controlled epidural analgesia (CI-PCEA) and programed intermittent epidural boluses (PIEB) have been developed, adding to continuous infusion and PCEA for the maintenance of neuraxial analgesia. Postdural puncture headache (PDPH) and fever can occur secondary to labor epidural that both have clinical relevance for the care givers. Insights into the mechanism of epidural fever and treatment strategies for PDPH are outlined. Due to the increase in obesity the specific considerations for this patient group are discussed. New data have been presented for remifentanil, an ultra-shortly acting opioid, that is used in obstetric analgesia. Without breaking new data, the use of nitrous oxide especially by midwives has a kind of renaissance, and this will be discussed, too.
authors.affiliation: Department of Anaesthesia, Kantonsspital Baden, Im Ergel 1, 5404 Baden.
authors.forename: Michael
authors.initials: M
authors.lastname: Heesen
authors.affiliation: Department of Anaesthesiology, Erasmus University Medical Centre Rotterdam, s-Gravendijkwal 230, 3015 CE Rotterdam, The.
authors.forename: Markus
authors.initials: M
authors.lastname: Klimek
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods / Q000639:trends; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D016058:Analgesia, Patient-Controlled / Q000379:methods / Q000639:trends; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D009609:Nitrous Oxide / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D010880:Piperidines / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications; D011677:Punctures / Q000009:adverse effects; D000077208:Remifentanil
chemical_list: D000700:Analgesics; D010880:Piperidines; D009609:Nitrous Oxide; D000077208:Remifentanil
keywords: Epidural; inhalational; intravenous; obese patient; obstetric analgesia