48 - Regional techniques during pregnancy and delivery

Abstract

The anesthesia care of obstetric patients is dominated by regional anesthesia and analgesia, primarily neuraxial techniques (spinal, epidural, combined spinal-epidural). These techniques may need to be modified in the pregnant patient to adjust for the physiologic changes that accompany pregnancy. The anesthetic care of the obstetric patient must also consider effects on the fetus/neonate. In general, neuraxial compared to systemic analgesia/anesthesia results in less drug transfer across the placenta to the fetus. Neuraxial analgesia is the only analgesic technique that can provide complete analgesia for labor and vaginal delivery. Neuraxial anesthesia is considered the optimal technique for cesarean delivery. Postcesarean delivery analgesia is most often provided using multimodal analgesia which often includes single-shot neuraxial morphine analgesia. Neuraxial local anesthetics and opioids are usually combined for obstetric analgesia and anesthesia. They work synergistically, thus lower doses of both drugs are needed, contributing to decreased side effects from the both the local anesthetic and opioid. For parturients for whom neuraxial analgesia/anesthesia is not possible or not desired, other nerve blocks can be used to provide labor analgesia and postoperative analgesia (e.g., transversus abdominal plane block, quadratus lumborum block, pudendal nerve block).