Labor pain relief: a narrative review of the current state of the issue

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Labor is inherently associated with pain. Pain during childbirth arises from both psychological and physiological processes, including myometrial ischemia and tissue stretching. It is considered one of the most painful physiological events experienced by women and has a direct impact on postpartum quality of life. Although pharmacologic pain relief is widely used in current clinical practice, it is often associated with adverse effects and financial costs. These factors, together with patients’ individual and cultural preferences, may encourage the choice of non-pharmacologic methods. This review summarizes fundamental information and presents recent research findings regarding the advantages and disadvantages of pharmacologic and non-pharmacologic methods of labor pain relief. Non-pharmacologic methods activate the body’s endogenous analgesic mechanisms, promote relaxation, reduce anxiety, and enhance birth satisfaction. Their low cost, minimal invasiveness, and absence of significant adverse effects make them an attractive option for many women. These methods can reduce pain intensity and should be integrated into practice when patients prefer to avoid neuraxial analgesia or pharmacologic interventions to ensure a more comfortable labor process. However, limited analgesic efficacy, low prevalence of use, and insufficient knowledge and skills remain barriers to their implementation. Pharmacologic methods of pain relief may be used in patients for whom neuraxial analgesia is contraindicated; however, they are often associated with decreased satisfaction with childbirth, as well as a number of adverse effects (including labor dysfunction, hypotension, elevated body temperature, nausea and vomiting, and prolonged duration of labor) affecting both the mother and the newborn. The choice of analgesic method should be individualized, taking into account maternal preferences, obstetric context, the presence of comorbidities, and their potential impact on labor progression.

Full Text

Restricted Access

About the authors

Nikita S. Shnyakin

Orenburg State Medical University

Author for correspondence.
Email: snhfromdol@mail.ru
ORCID iD: 0000-0003-2496-7438
SPIN-code: 1167-2539

student

Russian Federation, Orenburg

Denis V. Aksenenko

Stavropol State Medical University

Email: Dr.aksenenko@mail.ru
ORCID iD: 0000-0003-2820-3160
SPIN-code: 3948-2147

MD, Cand. Sci. (Med.)

Russian Federation, Stavropol

Maria S. Klimik

Stavropol State Medical University

Email: Mariaklimik1311@yandex.ru
ORCID iD: 0009-0005-6439-0022

student

Russian Federation, Stavropol

Yana S. Ivannikova

Stavropol State Medical University

Email: Yana_iv_banana@mail.ru
ORCID iD: 0009-0000-3839-2263

student

Russian Federation, Stavropol

Patima M. Mammaeva

Stavropol State Medical University

Email: patimamammaeva4@gmail.com
ORCID iD: 0009-0001-8699-1161

student

Russian Federation, Stavropol

Kristina K. Mukha

Stavropol State Medical University

Email: kristinapups2020@gmail.com
ORCID iD: 0009-0006-5575-0572

student

Russian Federation, Stavropol

Khadizhat A. Maaeva

Stavropol State Medical University

Email: maaevakhadizhat@icloud.com
ORCID iD: 0009-0007-8476-4399

student

Russian Federation, Stavropol

Ulyana A. Roshchina

Stavropol State Medical University

Email: vlasovaulya@yandex.ru
ORCID iD: 0009-0001-8553-8058

student

Russian Federation, Stavropol

Sofia R. Lepshokova

Stavropol State Medical University

Email: lepshokovasofka@gmail.com
ORCID iD: 0009-0000-7269-699X

student

Russian Federation, Stavropol

Sofia A. Kachalkina

Stavropol State Medical University

Email: kachalkinasofia@mail.ru
ORCID iD: 0009-0003-8078-0843

student

Russian Federation, Stavropol

Lada R. Kharlamova

Stavropol State Medical University

Email: Lada_kharlamova@inbox.ru
ORCID iD: 0009-0000-2078-1180

student

Russian Federation, Stavropol

Victoria A. Udod

Stavropol State Medical University

Email: vikulya-udod@mail.ru
ORCID iD: 0009-0002-7070-9528

student

Russian Federation, Stavropol

Victor M. Pustovetov

Stavropol State Medical University

Email: pustov5555_m@mail.ru
ORCID iD: 0009-0006-3577-3224

student

Russian Federation, Stavropol

Darya A. Buyavchikova

Stavropol State Medical University

Email: dbuyavchikova@mail.ru
ORCID iD: 0009-0002-7666-5423

student

Russian Federation, Stavropol

References

  1. Upriamova EIu, Krasnopol’skiĭ VI, Shifman EM. Pathophysiological bases of pain syndrome during labor. Russian Bulletin of Obstetrician-Gynecologist. 2017;17(5):13–17. doi: 10.17116/rosakush201717513-17
  2. Kearns RJ, Kyzayeva A, Halliday LOE, et al. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. 2024;385:e077190. doi: 10.1136/bmj-2023-077190
  3. Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186(5):16–24. doi: 10.1067/mob.2002.121427
  4. Smith A, Laflamme E, Komanecky C. Pain Management in Labor. Am Fam Physician. 2021;103(6):355–364.
  5. Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018;6(6):CD007396. doi: 10.1002/14651858.CD007396.pub3
  6. Cornet MC, Kuzniewicz MW, Scheffler AW, et al. Epidural Analgesia During Labor and Neonatal Hypoxic-Ischemic Encephalopathy. JAMA Netw Open. 2024;7(9):e2433730. doi: 10.1001/jamanetworkopen.2024.33730
  7. Kossova AA, Aksenov AN, Bocharova II, Yakubina AA, Upryamova EYu. Some aspects of labor anesthesia from the position of a neonatologist. Russian Bulletin of Obstetrician-i. 2024;24(5):34–41. doi: 10.17116/rosakush20242405134
  8. Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: A narrative review. Int J Gynaecol Obstet. 2022;159(2):356–364. doi: 10.1002/ijgo.14175
  9. Mwakawanga DL, Sirili N, Chikwala VZ, Mselle LT. “…We never considered it important…”: a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania. BMC Nurs. 2024;23(1):514. doi: 10.1186/s12912-024-02187-2
  10. Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol. 2022;36(1):37–51. doi: 10.1016/j.bpa.2022.04.005
  11. Boselli E, Hopkins P, Lamperti M, et al. European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia): Peripheral nerves blocks and neuraxial anaesthesia. Eur J Anaesthesiol. 2021;38(3):219–250. doi: 10.1097/EJA.0000000000001383
  12. Baljon K, Romli MH, Ismail AH, et al. Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial. Int J Womens Health. 2022;14:279–295. doi: 10.2147/IJWH.S347971
  13. Souto SPAD, Silva RCGD, Prata AP, et al. Midwives’ interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth. 2022;20(12):2867–2935. doi: 10.11124/JBIES-21-00382
  14. Kaple GS, Patil S. Effectiveness of Jacobson Relaxation and Lamaze Breathing Techniques in the Management of Pain and Stress During Labor: An Experimental Study. Cureus. 2023;15(1):e33212. doi: 10.7759/cureus.33212
  15. Heim MA, Makuch MY. Breathing Techniques During Labor: A Multinational Narrative Review of Efficacy. J Perinat Educ. 2023;32(1):23–34. doi: 10.1891/JPE-2021-0029
  16. Akca A, Corbacioglu Esmer A, et al. The influence of the systematic birth preparation program on childbirth satisfaction. Arch Gynecol Obstet. 2017;295:1127–1133. doi: 10.1007/s00404-017-4345-5
  17. Pietrzak J, Mędrzycka-Dąbrowska W, Wróbel A, Grzybowska ME. Women’s Knowledge about Pharmacological and Non-Pharmacological Methods of Pain Relief in Labor. Healthcare (Basel). 2023;11(13):1882. doi: 10.3390/healthcare11131882
  18. Robinson CL, Berger A, Sottosanti E, et al. Acupuncture as Part of Multimodal Analgesia for Chronic Pain. Orthop Rev (Pavia). 2022;14(3):38321. doi: 10.52965/001c.38321
  19. Gönenç IM, Terzioğlu F. Effects of Massage and Acupressure on Relieving Labor Pain, Reducing Labor Time, and Increasing Delivery Satisfaction. J Nurs Res. 2020;28(1):e68. doi: 10.1097/jnr.0000000000000344
  20. Türkmen H, Çetinkaya S, Kiliç H, et al. The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial. J Midwifery Womens Health. 2024;69(4):491–498. doi: 10.1111/jmwh.13600
  21. Nesheim BI, Kinge R, Berg B, et al. Acupuncture during labor can reduce the use of meperidine: a controlled clinical study. Clin J Pain. 2003;19(3):187–191. doi: 10.1097/00002508-200305000-00006
  22. Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002;81(10):943–948. doi: 10.1034/j.1600-0412.2002.811008.x
  23. Zamora-Brito M, Fernández-Jané C, Pérez-Guervós R, et al. The role of acupuncture in the present approach to labor induction: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2024;6(2):101272. doi: 10.1016/j.ajogmf.2023.101272
  24. Smith CA, Collins CT, Levett KM, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev. 2020;2(2):CD009232. doi: 10.1002/14651858.CD009232.pub2
  25. Lai CY, Wong MKW, Tong WH, et al. Effectiveness of a childbirth massage programme for labour pain relief in nulliparous pregnant women at term: a randomised controlled trial. Hong Kong Med J. 2021;27(6):405–412. doi: 10.12809/hkmj208629
  26. ACOG Committee Opinion No. 766 Summary: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019;133(2):406–408. doi: 10.1097/AOG.0000000000003081
  27. Savona-Ventura C, Mahmood T. The role of traditional complementary physical interventions in obstetrics — A scientific review commissioned by the European board and college of obstetrics and gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol. 2022;279:84–87. doi: 10.1016/j.ejogrb.2022.10.009
  28. WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513809/
  29. Liao CC, Lan SH, Yen YY, et al. Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis. J Obstet Gynaecol. 2021;41(1):21–31. doi: 10.1080/01443615.2019.1673707
  30. Tanvisut R, Traisrisilp K, Tongsong T. Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial. Arch Gynecol Obstet. 2018;297(5):1145–1150. doi: 10.1007/s00404-018-4700-1
  31. Tabatabaeichehr M, Mortazavi H. The Effectiveness of Aromatherapy in the Management of Labor Pain and Anxiety: A Systematic Review. Ethiop J Health Sci. 2020;30(3):449–458. doi: 10.4314/ejhs.v30i3.16
  32. McKinney JA, Vilchez G, Jowers A, et al. Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes. Am J Obstet Gynecol. 2024;230(3S):S961–S979.e33. doi: 10.1016/j.ajog.2023.08.034
  33. Liao CC, Lan SH, Yen YY, et al. Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis. J Obstet Gynaecol. 2021;41(1):21–31. doi: 10.1080/01443615.2019.1673707
  34. Burns E, Feeley C, Hall PJ, Vanderlaan J. Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth. BMJ Open. 2022;12(7):e056517. doi: 10.1136/bmjopen-2021-056517
  35. Neiman E, Austin E, Tan A, et al. Outcomes of Waterbirth in a US Hospital-Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth. J Midwifery Womens Health. 2020;65(2):2162–2123. doi: 10.1111/jmwh.13033
  36. Bailey JM, Zielinski RE, Emeis CL, Kane Low L. A retrospective comparison of waterbirth outcomes in two United States hospital settings. Birth. 2020;47(1):98–104. doi: 10.1111/birt.12473
  37. Adamyan LV, Artymuk NV, Belokrinitskaia TE, et al. Neuroxial methods of labor analgesia. Clinical guidelines. Russian Journal of Anesthesiology and Reanimatology. 2018;(5):99–110. doi: 10.17116/anaesthesiology201805199
  38. Pismensky SV, Zolotareva LS, Baev OR, et al. Current state of the problem of pain relief in childbirth. Obstetrics and Gynecology. 2023;2:26–31. doi: 10.18565/aig.2022.273
  39. Likis FE, Andrews JC, Collins MR, et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg. 2014;118(1):153–167. doi: 10.1213/ANE.0b013e3182a7f73c
  40. Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol. 2022;36(1):37–51. doi: 10.1016/j.bpa.2022.04.005
  41. Seglenieks R, Wong A, Pearson F, McGain F. Discrepancy between procurement and clinical use of nitrous oxide: waste not, want not. Br J Anaesth. 2022;128(1):e32–e34. doi: 10.1016/j.bja.2021.10.021
  42. Sharpe EE, Warner LL, Brakke BD, et al. Impact of nitrous oxide use on parturient recall of neuraxial analgesia risks. J Clin Anesth. 2024;98:111579. doi: 10.1016/j.jclinane.2024.111579
  43. Zuarez-Easton S, Zafran N, Garmi G, et al. Meperidine Compared With Nitrous Oxide for Intrapartum Pain Relief in Multiparous Patients: A Randomized Controlled Trial. Obstet Gynecol. 2023;141(1):4–10. doi: 10.1097/AOG.0000000000005011
  44. Nanji JA, Carvalho B. Pain management during labor and vaginal birth. Best Pract Res Clin Obstet Gynaecol. 2020;67:100–112. doi: 10.1016/j.bpobgyn.2020.03.002
  45. Аrbuck DM, Аbuzarova GR, Аlekseeva GS. Opioids in pain syndrome management (part 2). Messenger of Anesthesiology and Resuscitation. 2017;14(4):61–71. doi: 10.21292/2078-5658-2017-14-4-61-71
  46. Vvedenskaya ES, Pevnev AA, Molkov AM. Serotonin syndrome: focus on opioid analgesics. Russian Journal of Pain. 2024;22(3):98–106. doi: 10.17116/pain20242203198
  47. Zuarez-Easton S, Erez O, Zafran N, et al. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol. 2023;228(5S):S1246–S1259. doi: 10.1016/j.ajog.2023.03.003
  48. Alsmadi MM, Idkaidek N. The Analysis of Pethidine Pharmacokinetics in Newborn Saliva, Plasma, and Brain Extracellular Fluid After Prenatal Intrauterine Exposure from Pregnant Mothers Receiving Intramuscular Dose Using PBPK Modeling. Eur J Drug Metab Pharmacokinet. 2023;48(3):281–300. doi: 10.1007/s13318-023-00823-x
  49. Moe-Byrne T, Brown JVE, McGuire W. Naloxone for opioid-exposed newborn infants. Cochrane Database Syst Rev. 2018;10(10):CD003483. doi: 10.1002/14651858.CD003483.pub3
  50. Show KL, Ngamjarus C, Kongwattanakul K, et al. Fentanyl for labour pain management: a scoping review. BMC Pregnancy Childbirth. 2022;22(1):846. doi: 10.1186/s12884-022-05169-x
  51. Wydall S, Zolger D, Owolabi A, et al. Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis. Comparaison des différentes modalités d’administration de l’analgésie péridurale et de l’analgésie intraveineuse pendant le travail obstétrical revue systématique et méta-analyse en réseau. Can J Anaesth. 2023;70(3):406–442. doi: 10.1007/s12630-022-02389-9
  52. Douma MR, Verwey RA, Kam-Endtz CE, et al. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2010;104(2):209–215. doi: 10.1093/bja/aep359
  53. Stourac P, Kosinova M, Harazim H, et al. The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(1):30–38. doi: 10.5507/bp.2015.043
  54. Volikas I, Male D. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. Int J Obstet Anesth. 2001;10(2):86–90. doi: 10.1054/ijoa.2000.0831
  55. Lei X, Yu Y, Li M, et al. The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review. PLoS One. 2022;17(12):e0275716. doi: 10.1371/journal.pone.0275716
  56. Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth. 2016;25:66–74. doi: 10.1016/j.ijoa.2015.12.004
  57. Cai M, Liu J, Lei XF, et al. Remifentanil at a Relatively Elevated Dose in Active Phase is Safe and More Suitable Than Fixed Lower Dose for Intravenous Labor Analgesia. J Pain Res. 2023;16:2543–2552. doi: 10.2147/JPR.S419076
  58. Karol D, Weiniger CF. Update on Non-neuraxial Labor Analgesia. Curr Anesthesiol Rep. 2021;11(3):348–354. doi: 10.1007/s40140-021-00463-4
  59. Melber AA, Jelting Y, Huber M, et al. Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010–2015). Int J Obstet Anesth. 2019;39:12–21. doi: 10.1016/j.ijoa.2018.12.004
  60. Huang CY, Li SX, Yang MJ, et al. A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia. Chin Med J (Engl). 2020;133(5):523–529. doi: 10.1097/CM9.0000000000000678
  61. Monisha N, Poomalar GK. Comparison of intravenous paracetamol infusion versus intramuscular tramadol as labor analgesia: a randomized control trial. Arch Gynecol Obstet. 2023;307(3):755–762. doi: 10.1007/s00404-022-06585-2
  62. Makharin OA, Lebedeva EA, Kochubeynik NV Conduction methods of pain relief in labor: a systematic review. Bulletin of Intensive Therapy named after A.I. Saltanov. 2022;(4):55–65. doi: 10.21320/1818-474X-2022-4-55-65
  63. Weiniger CF, Carvalho B, Stocki D, Einav S. Analysis of Physiological Respiratory Variable Alarm Alerts Among Laboring Women Receiving Remifentanil. Anesth Analg. 2017;124(4):1211–1218. doi: 10.1213/ANE.0000000000001644
  64. Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018;6(6):CD007396. doi: 10.1002/14651858.CD007396.pub3
  65. Lukasse M, Bratsberg AB, Thomassen K, Nøhr EA. Use of pudendal nerve block among midwives in Norway: A national cross-sectional study. Eur J Midwifery. 2022;6:34. doi: 10.18332/ejm/146690
  66. Helmer P, Skazel T, Wenk M, et al. S3-Leitlinie “Vaginale Geburt am Termin “aus anästhesiologischer Sicht: Wissenswertes für den Anästhesisten” [S3 guidelines on “full-term vaginal birth” from an anesthesiological perspective: Worthwhile knowledge for anesthesiologists]. Anaesthesist. 2021;70(12):1031–1039. doi: 10.1007/s00101-021-01024-4
  67. Ford JM, Owen DJ, Coughlin LB, Byrd LM. A critique of current practice of transvaginal pudendal nerve blocks: a prospective audit of understanding and clinical practice. J Obstet Gynaecol. 2013;33(5):463–465. doi: 10.3109/01443615.2013.771155
  68. Xu J, Zhou R, Su W, et al. Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial. BMJ Open. 2020;10(8):e035887. doi: 10.1136/bmjopen-2019-035887
  69. Nikpoor P, Bain E. Analgesia for forceps delivery. Cochrane Database Syst Rev. 2013;9(9):CD008878. doi: 10.1002/14651858.CD008878.pub2
  70. Adamyan LV, Artymuk NV, Belokrinitskaia TE, et al. Neuroxial methods of labor analgesia. Clinical guidelines. Russian Journal of Anesthesiology and Reanimatology. 2018;(5):99–110. doi: 10.17116/anaesthesiology201805199
  71. Delgado C, Bollag L, Van Cleve W. Neuraxial Labor Analgesia Utilization, Incidence of Postdural Puncture Headache, and Epidural Blood Patch Placement for Privately Insured Parturients in the United States (2008–2015). Anesth Analg. 2020;131(3):850–856. doi: 10.1213/ANE.0000000000004561
  72. Ulrikh GE, Ryazanova OV, Zabolotskii DV, et al. Spinal anesthesia during cesarean section in a patient with multi-support construction after previous correction of spinal deformity. Russian Journal of Anesthesiology and Reanimatology. 2023;(3):67–71. doi: 10.17116/anaesthesiology202303167
  73. Gonzalez MN, Trehan G, Kamel I. Pain management during labor part 2: Techniques for labor analgesia. Topics Obstetr. Gynecology. 2016; 36(12):1–8.
  74. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4
  75. Simmons SW, Cyna AM, Dennis AT, Hughes D. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2007;(3):CD003401. doi: 10.1002/14651858.CD003401.pub2
  76. Ovechkin AM, Sokologorskiy SV. The old technique of combined spinal-epidural anesthesia and new opportunities for its implementation. Regional Anesthesia and Acute Pain Management. 2018;12(1):64–67. doi: 10.17816/RA42894
  77. Skupski DW, Abramovitz S, Samuels J, et al. Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor. Int J Gynaecol Obstet. 2009;106(3):242–245. doi: 10.1016/j.ijgo.2009.04.019
  78. Simmons SW, Taghizadeh N, Dennis AT, et al. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012;10(10):CD003401. doi: 10.1002/14651858.CD003401.pub3
  79. Shakirov RT, Kinzhalova SV, Makarov RА. Neuraxial methods of pain relief in labor. Messenger of Anesthesiology and Resuscitation. 2018;15(5): 65–73. doi: 10.21292/2078-5658-2018-15-5-65-73
  80. Wilson SH, Wolf BJ, Bingham K, et al. Labor Analgesia Onset with Dural Puncture Epidural Versus Traditional Epidural Using a 26-Gauge Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial. Anesth Analg. 2018;126(2):545–551. doi: 10.1213/ANE.0000000000002129
  81. Chau A, Bibbo C, Huang CC, et al. Dural Puncture Epidural Technique Improves Labor Analgesia Quality with Fewer Side Effects Compared with Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesth Analg. 2017;124(2):560–569. doi: 10.1213/ANE.0000000000001798
  82. Tan HS, Reed SE, Mehdiratta JE, et al. Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study. Anesthesiology. 2022;136(5):678–687. doi: 10.1097/ALN.0000000000004137
  83. Roofthooft E, Rawal N, Van de Velde M. Current status of the combined spinal-epidural technique in obstetrics and surgery. Best Pract Res Clin Anaesthesiol. 2023;37(2):189–198. doi: 10.1016/j.bpa.2023.04.004
  84. Berger AA, Jordan J, Li Y, et al. Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study. Int J Obstet Anesth. 2022;52:103590. doi: 10.1016/j.ijoa.2022.103590

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1. The algorithm for selecting primary sources.

Download (248KB)

Copyright (c) 2025 Eco-Vector



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г
.