Analgesia obstétrica

Avances en analgesia obstétrica  Advances in labor analgesia. Wong CA. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Int J Womens Health. 2010 Aug 9;1:139-54. 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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971706/pdf/ijwh-1-139.pdf   Analgesia epidural opioide y depresión respiratoria neonatal Epidural opioid analgesia and neonatal respiratory depression. Kumar M, Paes B. Department of Pediatrics, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Canada. J Perinatol. 2003 Jul-Aug;23(5):425-7. Abstract Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews the maternal-fetal-placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression. http://www.nature.com/jp/journal/v23/n5/pdf/7210905a.pdf

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org