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Review Article | DOI: https://doi.org/10.31579/2692-9562/112
Assistant Vice President for Clinical Education Development, A.T. Still University.
*Corresponding Author: Leonard B. Goldstein, Assistant Vice President for Clinical Education Development, A.T. Still University.
Citation: Andrew Igbokwe, Aarushi Gulati, James Keane, Leonard B. Goldstein, (2024). Epidural Anesthesia for Labor and Delivery, Journal of Clinical Otorhinolaryngology, 6(2); DOI:10.31579/2692-9562/112
Copyright: © 2024, Leonard B. Goldstein. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Received: 07 February 2024 | Accepted: 16 February 2024 | Published: 26 February 2024
Keywords: autism; cerebrolysin; cures
Epidural anesthesia has cemented itself as a mainstay in the process of maximizing patient safety and comfort during childbirth or similar measures of pain. The research reviewed in this paper highlights the efficacy and safety of epidural anesthesia while also discussing new advances in optimization of anesthesia. Further discussion of this topic is pertinent to standardization of technique as well as consolidating existing information on the benefits and potential pitfalls of epidural anesthesia treatment as well as the mechanism of action and dosing compounds of epidural anesthesia within the context of pain management for laboring women. The review of clinical literature and large-scale data collection is essential for investigating and confirming any claims, negative or otherwise. Exploration of the literature was categorized into techniques of administration, mechanism of action, and risks associated with epidural anesthesia use for both the fetus and mother. Ultimately, the evidence uncovered in this research points towards safe and replicable standard procedures with continued efforts to perfect anesthetic administration. Notably, possibilities for further research could be discussing the specific variables factoring into the physician’s decision of epidural anesthesia technique and dosing blend as well as comparing single-dose spinal analgesia to epidural analgesia.
Labor is consistently rated as one of the most painful life experiences.1 Labor pain consists of the visceral and somatic components, the former occurring during the first two stages of childbirth and the latter taking place during the last two stages of labor.1 Painful labor may be a problem for both the mother and the fetus by adversely affecting several physiological processes, such as hypertension in pre-eclampsia, insensitivity to angiotensin II, and compensated respiratory alkalosis.2 Changes in these physiological processes can be detrimental to not only the mother, but the infant as well. This necessitates ensuring adequate analgesia during labor.
There are several pain management options available to ease the pain of labor and delivery. These include pharmacological solutions, such as epidural anesthesia, and non-pharmacological options, such as iyengar yoga, acupuncture, and warm packs.3 Epidural anesthesia is among the foremost strategies for pain management during labor and delivery.4 Epidurals are employed as an anesthetic for thoracic, major intra-abdominal, or spine surgery.5 Studies have revealed lower pain scores following epidural analgesia leading to higher maternal satisfaction.4 Epidural anesthesia is also associated with better maternal cardiovascular, pulmonary, and fetal physiology.6,7 Epidural anesthesia decreases pain of the uterine contraction and assists in controlling blood pressure.2 Additionally, the peripheral vessels are enhanced by the sympathetic blockade, which reduces the cause of peripheral vasodilation.8-10 Spinal administration of local anesthetics in combination with opioids is utilized for pain management in labor and delivery due to its dose limiting effects and reduced adverse effects.11-13 Possible disadvantages with epidural anesthesia are prolonged labor, increased financial burden, intrapartum fever, dural puncture, postpartum headache and limitation in the mother’s participation and sense of control in the birth of her child.3 Because this method has a 8.5
Painful labor is detrimental for the mother and fetus alike; as such, it is critical to employ effective measures towards pain reduction in childbirth.2 Epidural anesthesia provides this solution and is often used for pain management during labor and delivery.4,24 Epidural anesthesia decreases pain of the uterine contraction via sympathetic nervous signal blockage.2,8-10 Epidural anesthesia is administered in the epidural space of the spinal cord, which lies between the outermost meningeal layer, the dura mater, and vertebral wall.15 A catheter is inserted in the epidural space, which lies distal to L1 surrounding spinal nerve roots, and the epidural needle is placed for the administration of analgesic substances.17 Results from the various studies discussed in this paper reiterate the benefits of epidural anesthesia.
Techniques developed for administering epidural anesthesia have advanced in their efficacy and accuracy. LOR and, more recently, electrical stimulation have shown promise in greatly reducing the variability in success rate of epidural anesthesia in relation to the practitioner’s experience by shrinking the margin of error when identifying the epidural space.16 As more studies are being conducted, this technique is being refined and evidence is steadily being gathered to categorize the LOR technique as a low to zero risk procedure. In addition to the alterations in techniques and tools, there are variations in depth of anesthetic administration as well as different drug combinations based on perceived pain and risks associated with the specific patient.17 Further, patients are highly involved in treatment with the use of patient-controlled epidural analgesia, and computer integrated patient-controlled epidural analgesia leading to more accurate pain control and greater patient satisfaction.14 While there are advances being made in the safety of this treatment, there are also possible risks associated with epidural anesthesia.25 Current patient condition, medications, and history of previous disease can increase risk of developing post-dural puncture headaches.25 Nevertheless, the benefits of epidural anesthesia extend to even the fetus, illustrated by reduced need for medical intervention following birth in comparison to children whose mothers are administered predominantly opioids during childbirth.27
While synthesizing existing research on epidural anesthesia, the development of standard technique and efforts made to perfect this safe and constructive procedure are evident. The results included in this paper demonstrate tangible evidence of positive correlation between patient outcomes and the advancement of epidural anesthetic usage. As the risks and benefits of epidural anesthesia use are carefully examined over years of research and experience, the refining process for this procedure is much more effective and tailored to the patient. While the LOR technique, a widely successful and accepted technique, is preferred for the classic epidural, studies on supplemental pain management methods, such as electrical stimulation are also showing promising results in terms of improving procedural success.16 With improvement in overall patient experience and efficacy, instances of births complicated by maternal distress should continue to fall and more patients feel comfortable with the procedure. Childbirth, or similar states of pain that require extensive measures to alleviate, is a very vulnerable state for a patient to be in. The incorporation of real time patient involvement with their own care in terms of pain control yields higher patient satisfaction and experience.14 While epidural anesthesia has proven to be efficacious, providers must use caution and consider the condition of the patient while selecting the best form of anesthesia.25 This is the first step in granting the patient autonomy with respect to their healthcare.
With the amount of research on epidural anesthesia, it is hard to imagine any bias being incorporated into the studies. However, the data on the demographics of the women sampled was not present in most studies. It would be interesting to explore the socioeconomic status of patients as well as specifics of the pregnancy, such as mother age and fetus gestation. These changes would allow the data to be more reflective of the population and definitively portray epidural anesthesia as a safe and effective procedure regardless of the aforementioned variables. There are also questions as to why there isn’t one technique that has been identified as being the gold standard. Further research on each technique’s efficacy in different populations of pregnant patients would be beneficial in uncovering the most optimal technique across any variance in patients. Additionally, it could be an interesting and particularly relevant avenue to explore the risks and benefits of single-dose spinal analgesia, compared to epidural analgesia as it has been mentioned as a safe and efficient alternative for labor analgesia.4
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