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Advances in labor analgesia.

Wong CA - Int J Womens Health (2010)

Bottom Line: Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study.Intradermal water injections decrease back labor pain.Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

ABSTRACT
The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

No MeSH data available.


Related in: MedlinePlus

Comparison of pain scores using the McGill Pain Questionnaire obtained from women during labor and from patients in general hospital clinics and an emergency department. The pain rating index (PRI) represents the sum of the rank values for all words chosen from 20 sets of pain descriptions. From Melzack R. The myth of painless childbirth [The John J. Bonica Lecture]. Pain. 1984;19(4):321–337.4 Copyright © 1984. This figure has been reproduced with permission of the International Association for the study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.
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f1-ijwh-1-139: Comparison of pain scores using the McGill Pain Questionnaire obtained from women during labor and from patients in general hospital clinics and an emergency department. The pain rating index (PRI) represents the sum of the rank values for all words chosen from 20 sets of pain descriptions. From Melzack R. The myth of painless childbirth [The John J. Bonica Lecture]. Pain. 1984;19(4):321–337.4 Copyright © 1984. This figure has been reproduced with permission of the International Association for the study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.

Mentions: Although the amount of pain and suffering associated with labor and vaginal delivery varies widely among parturients, few well-designed studies on the prevalence, intensity, and quality of labor pain have been performed. Melzack and colleagues used the McGill Pain Questionnaire to measure pain during labor and delivery (Figure 1).4 Nulliparous women had a higher total mean pain rating index (PRI) than parous women. Significant differences were also found between iparous and parous women in the sensory qualities of pain. Although scores ranged from mild to excruciating, the PRI scores of laboring women were 8 to 10 points higher than those associated with cancer pain, phantom limb pain, and postherpetic neuralgia.


Advances in labor analgesia.

Wong CA - Int J Womens Health (2010)

Comparison of pain scores using the McGill Pain Questionnaire obtained from women during labor and from patients in general hospital clinics and an emergency department. The pain rating index (PRI) represents the sum of the rank values for all words chosen from 20 sets of pain descriptions. From Melzack R. The myth of painless childbirth [The John J. Bonica Lecture]. Pain. 1984;19(4):321–337.4 Copyright © 1984. This figure has been reproduced with permission of the International Association for the study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2971706&req=5

f1-ijwh-1-139: Comparison of pain scores using the McGill Pain Questionnaire obtained from women during labor and from patients in general hospital clinics and an emergency department. The pain rating index (PRI) represents the sum of the rank values for all words chosen from 20 sets of pain descriptions. From Melzack R. The myth of painless childbirth [The John J. Bonica Lecture]. Pain. 1984;19(4):321–337.4 Copyright © 1984. This figure has been reproduced with permission of the International Association for the study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.
Mentions: Although the amount of pain and suffering associated with labor and vaginal delivery varies widely among parturients, few well-designed studies on the prevalence, intensity, and quality of labor pain have been performed. Melzack and colleagues used the McGill Pain Questionnaire to measure pain during labor and delivery (Figure 1).4 Nulliparous women had a higher total mean pain rating index (PRI) than parous women. Significant differences were also found between iparous and parous women in the sensory qualities of pain. Although scores ranged from mild to excruciating, the PRI scores of laboring women were 8 to 10 points higher than those associated with cancer pain, phantom limb pain, and postherpetic neuralgia.

Bottom Line: Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study.Intradermal water injections decrease back labor pain.Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

ABSTRACT
The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

No MeSH data available.


Related in: MedlinePlus