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Pain relief in maternity care and the role of the obstetric anaesthetist

Published:December 16, 2022DOI:https://doi.org/10.1016/j.ogrm.2022.11.003

      Abstract

      Pain is a common and treatable symptom in all stages of pregnancy. All agents must be prescribed considering the perceived benefits whilst acknowledging the potential fetal adverse effects. Oral agents can be used safely and effectively during the antenatal period, and management must be tailored for each individual. Intrapartum analgesia should be multi-modal with consideration for complimentary therapies including continuous labour support and water immersion. Epidural anaesthesia is the gold standard for pain management in labour, with inhalation anaesthetic offering excellent adjunct analgesia. A combined spinal/epidural anaesthesia acts rapidly compared to traditional epidural. Pudendal nerve blocks are effective methods of analgesia with decreasing popularity. Transversus abdominis plane blocks and wound infiltration of local anaesthetic reduces post-operative requirement for opioids. The obstetric anaesthetist plays a significant role in the multidisciplinary team in identifying and planning care for high-risk individuals. Furthermore, anaesthetic intervention at the time of delivery is not infrequent and can be optimized.

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      Further reading

        • Bisson D.L.
        • Newell S.D.
        • Laxton C.
        Antenatal and postnatal analgesia: scientific impact paper No. 59.
        BJOG An Int J Obstet Gynaecol. 2018; 126: e114-e124https://doi.org/10.1111/1471-0528.15510
        • Cook T.
        Major complications of central neuraxial blocks: the 3rd national audit project of the royal college of anaesthetists.
        Nat Audit Project. 2009; https://doi.org/10.1097/01.sa.0000351785.16340.96
        • Jones L.
        • Othman M.
        • Dowswell T.
        • et al.
        Pain management for women in labour: an overview of systematic reviews (Review).
        Cochrane Database Syst Rev. 2012; https://doi.org/10.1002/14651858.CD009234.pub2
        • Ockenden D.
        Findings, conclusions and essential actions from the independent review of maternity services.
        2022
      1. UK Teratology Information Service Best use of medicines in pregnancy (BUMPs). Available at: https://www.medicinesinpregnancy.org/bumps/Medicine–pregnancy.