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Reducing breakthrough pain during labour epidural analgesia

an update

Tan, Hon Sena; Sng, Ban Leonga,b; Sia, Alex Tiong Henga,b

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 307–314
doi: 10.1097/ACO.0000000000000713

Purpose of review Neuraxial techniques are the current gold standard for labour analgesia, but are associated with up to 25% incidence of breakthrough pain. In this review, we aim to update clinicians on the latest research pertaining to the optimization of neuraxial labour analgesia.

Recent findings Attempts to improve the efficacy and reliability of epidural analgesia while minimizing adverse effects have resulted in the rising popularity of combined spinal epidural and the dural puncture epidural (DPE). Recent studies have focused on determining the safety, efficacy, and optimization of the DPE technique.

Another research focus is on the development of individualized therapy in which patients may titrate their own labour analgesia according to their varying requirements, possibly augmented with computer-aided feedback systems and automated mandatory bolus techniques that automatically adjust drug delivery to the patients’ analgesic requirements. The addition of a risk-stratification model based on maternal, anaesthetic, and obstetric factors will facilitate early institution of individualized therapy to forestall breakthrough pain in higher risk patients.

Summary Recent advances in combined spinal epidural, DPE, automated mandatory bolus, and individualized therapies have advanced our goal of providing effective labour analgesia that is titrated to changing analgesic requirements during labour and delivery and reducing breakthrough pain.

aDepartment of Women's Anaesthesia, KK Women's and Children's Hospital

bAnaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore

Correspondence to Ban Leong Sng, MBBS, MMED, FANZCA, FFPMANZC, MCI, Department of Women's Anaesthesia, KK Women's and Children's Hospital; Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. Tel: +65 6394 1077; e-mail:

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