One of the Saturday sessions at this year’s Euroanaesthesia was on analgesia for labour and post-Caesarean delivery, presented by Professor Brendon Carvalho, Stanford University, CA, USA.
“The epidural labour analgesia part of my talk highlighted cutting-edge techniques to optimise neuraxial labour analgesia including pre-procedure neuraxial ultrasound imaging, combined spinal-epidural (CSE) and dural puncture epidural (DPE),” said Professor Carvalho. “Advantages of pre-procedure neuraxial ultrasound compared to landmark assessments were outlined.”
He discussed recent publications showing potential advantages of CSE and DPE over standard labour epidural analgesia. Optimal labour epidural maintenance techniques including programmed intermittent epidural boluses (PIEB) and patient-controlled epidural analgesia (PCEA) were highlighted and compared to traditional continuous epidural infusion techniques. The ideal local anaesthetic solutions, as well as optimal PCEA and PIEB settings to minimise the impact of epidurals on obstetric outcomes were also discussed.
The second half of Professor Carvalho’s talk outlined techniques to optimise post-Caesarean delivery analgesia, including multimodal analgesia approaches to reduce pain and minimise treatment-related side effects. The optimal neuraxial opioid dose, and opioid-sparing adjuncts such as non-steroidal anti-inflammatories, paracetamol, dexamethasone, gabapentin and ketamine were discussed. Recent studies that explored the role of local anaesthetic techniques to treat Caesarean delivery pain including continuous local anesthetic wound instillation, transversus abdominis plane blocks and quadratus lumborum blocks were highlighted. Finally, the potential transfer of analgesics including tramadol to the nursing infant via breastmilk were outlined.