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What's New in Neuraxial Labor Analgesia.
Curr Anesthesiol Rep. 2021 Aug 27 [Online ahead of print]CA

Abstract

Purpose of Review

This article provides an update of recent practice trends in neuraxial labor analgesia. It reviews available evidence regarding management of labor pain in obstetric patients with COVID-19, serious adverse events in obstetric anesthesia to help inform risk/benefit decisions, and increasingly popular neuraxial labor analgesia techniques and adjuvants. State-of-the-art modes of epidural drug delivery are also discussed.

Recent Findings

There has recently been a focus on several considerations specific to obstetric anesthesia, such as anesthetic management of obstetric patients with COVID-19, platelet thresholds for the safe performance of neuraxial analgesia in obstetric patients with thrombocytopenia, and drug delivery modes for initiation and maintenance of neuraxial labor analgesia.

Summary

Neuraxial labor analgesia (via standard epidural, dural puncture epidural, and combined spinal epidural techniques) is the most effective therapy to alleviate the pain of childbirth. SARS-CoV-2 infection is not, in and of itself, a contraindication to neuraxial labor analgesia or cesarean delivery anesthesia. Early initiation of neuraxial labor analgesia in patients with COVID-19 is recommended if not otherwise contraindicated, as it may reduce the need for general anesthesia should emergency cesarean delivery become necessary. Consensus regarding platelet thresholds for safe initiation of neuraxial procedures has historically been lacking. Recent studies have concluded that the risk of spinal epidural hematoma formation after neuraxial procedures is likely low at or above an imprecise range of platelet count of 70-75,000 × 106/L. Thrombocytopenia has been reported in obstetric patients with COVID-19, but severe thrombocytopenia precluding initiation of neuraxial anesthesia is extremely rare. High neuraxial blockade has emerged as one of the most common serious complications of neuraxial analgesia and anesthesia in obstetric patients. Growing awareness of factors that contribute to failed conversion of epidural labor analgesia to cesarean delivery anesthesia may help avoid the risks associated with performance of repeat neuraxial techniques and induction of general anesthesia after failed epidural blockade. Dural puncture techniques to alleviate the pain of childbirth continue to become more popular, as do adjuvant drugs to enhance or prolong neuraxial analgesia. Novel techniques for epidural drug delivery have become more widely disseminated.

Authors+Show Affiliations

NYU Langone Health, Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Hospital, Brooklyn, USA.Department of Anesthesia, Critical Care & Pain Medicine, Harvard Medical School, Boston, USA. Obstetric Anesthesia Division, Massachusetts General Hospital, Boston, MA USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34466127

Citation

Toledano, Roulhac D., and Lisa Leffert. "What's New in Neuraxial Labor Analgesia." Current Anesthesiology Reports, 2021, pp. 1-8.
Toledano RD, Leffert L. What's New in Neuraxial Labor Analgesia. Curr Anesthesiol Rep. 2021.
Toledano, R. D., & Leffert, L. (2021). What's New in Neuraxial Labor Analgesia. Current Anesthesiology Reports, 1-8. https://doi.org/10.1007/s40140-021-00453-6
Toledano RD, Leffert L. What's New in Neuraxial Labor Analgesia. Curr Anesthesiol Rep. 2021 Aug 27;1-8. PubMed PMID: 34466127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What's New in Neuraxial Labor Analgesia. AU - Toledano,Roulhac D, AU - Leffert,Lisa, Y1 - 2021/08/27/ PY - 2021/05/31/accepted PY - 2021/9/1/entrez PY - 2021/9/2/pubmed PY - 2021/9/2/medline KW - Accidental dural puncture KW - Anesthesia and analgesia KW - Bacterial meningitis KW - COVID-19 KW - Chronic headache KW - Combined spinal epidural KW - Dural puncture epidural KW - Epidural analgesia KW - Epidural blood patch KW - Failed epidural conversion KW - Gestational thrombocytopenia KW - HELLP syndrome KW - High neuraxial block KW - Hypertensive disorders of pregnancy KW - Immune thrombocytopenia KW - Immune thrombocytopenic purpura KW - Infectious complications KW - Neuraxial anesthesia KW - Patient-controlled epidural analgesia KW - Peripheral KW - Platelet count KW - Platelet threshold KW - Postdural puncture headache KW - Postpartum hemorrhage KW - Powered air-purifying respirator KW - Programmed intermittent epidural bolus KW - Single-shot spinal KW - Spinal cord injury KW - Spinal epidural abscess KW - Spinal epidural hematoma KW - Sterile precautions KW - Ultrasonography KW - Venous thromboembolism prophylaxis KW - Wire-reinforced epidural catheter SP - 1 EP - 8 JF - Current anesthesiology reports JO - Curr Anesthesiol Rep N2 - Purpose of Review: This article provides an update of recent practice trends in neuraxial labor analgesia. It reviews available evidence regarding management of labor pain in obstetric patients with COVID-19, serious adverse events in obstetric anesthesia to help inform risk/benefit decisions, and increasingly popular neuraxial labor analgesia techniques and adjuvants. State-of-the-art modes of epidural drug delivery are also discussed. Recent Findings: There has recently been a focus on several considerations specific to obstetric anesthesia, such as anesthetic management of obstetric patients with COVID-19, platelet thresholds for the safe performance of neuraxial analgesia in obstetric patients with thrombocytopenia, and drug delivery modes for initiation and maintenance of neuraxial labor analgesia. Summary: Neuraxial labor analgesia (via standard epidural, dural puncture epidural, and combined spinal epidural techniques) is the most effective therapy to alleviate the pain of childbirth. SARS-CoV-2 infection is not, in and of itself, a contraindication to neuraxial labor analgesia or cesarean delivery anesthesia. Early initiation of neuraxial labor analgesia in patients with COVID-19 is recommended if not otherwise contraindicated, as it may reduce the need for general anesthesia should emergency cesarean delivery become necessary. Consensus regarding platelet thresholds for safe initiation of neuraxial procedures has historically been lacking. Recent studies have concluded that the risk of spinal epidural hematoma formation after neuraxial procedures is likely low at or above an imprecise range of platelet count of 70-75,000 × 106/L. Thrombocytopenia has been reported in obstetric patients with COVID-19, but severe thrombocytopenia precluding initiation of neuraxial anesthesia is extremely rare. High neuraxial blockade has emerged as one of the most common serious complications of neuraxial analgesia and anesthesia in obstetric patients. Growing awareness of factors that contribute to failed conversion of epidural labor analgesia to cesarean delivery anesthesia may help avoid the risks associated with performance of repeat neuraxial techniques and induction of general anesthesia after failed epidural blockade. Dural puncture techniques to alleviate the pain of childbirth continue to become more popular, as do adjuvant drugs to enhance or prolong neuraxial analgesia. Novel techniques for epidural drug delivery have become more widely disseminated. SN - 1523-3855 UR - https://www.unboundmedicine.com/medline/citation/34466127/What's_New_in_Neuraxial_Labor_Analgesia_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34466127/ DB - PRIME DP - Unbound Medicine ER -
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