Maintaining labour epidural analgesia: what is the best option?

The intensity of labour pain is influenced by a multitude of factors. In this article, we discuss recent advances in the administration of labour epidural analgesia which have been targeted at creating a more satisfactory birthing experience for the parturient while safeguarding maternal and fetal well being. Induction of analgesia by the combined spinal epidural technique provides rapid onset of profound analgesia with minimal motor blockade, although the impact of the technique on overall maternal satisfaction with analgesia is equivocal. Patient-controlled epidural analgesia has gained acceptance among clinicians and parturients alike, and research has been focused on elucidating the optimal patient-controlled epidural analgesia programme settings. Results from laboratory and clinical studies suggest that intermittent epidural boluses may produce a more uniform block than a continuous basal infusion. Attempts have been made to incorporate background automated intermittent boluses into a patient-controlled epidural analgesia programme, with encouraging results. Computer-integrated patient-controlled epidural analgesia is a novel system that records the history of the patient's analgesic requirement over the past hour and increases its basal infusion rate proportionally to the number of demand-boluses made. The computer-integrated patient-controlled epidural analgesia programme appears to reduce the incidence of breakthrough pain without increasing drug consumption or side effects. Recent advances in medical technology have equipped us with many novel drug delivery modalities, which will enable us to customize a suitable analgesic regimen for each parturient.