Problems in obstetric analgesia

  • Pedro José Herrera Gómez a. Anesthesiology and Resuscitation, Universidad Nacional de Colombia, Bogotá, Colombia. b. Anesthesia Service, Instituto Materno Infantil, Bogotá, Colombia. c. Hospital de La Victoria, Bogotá, Colombia
  • Paula Andrea Medina Anesthesiology and Resuscitation, Universidad Nacional de Colombia, Bogotá, Colombia
Keywords: Obstetrics, Labor, Obstetric, Analgesia, Epidural, Parturition, Pain

Abstract

Despite countless statements from international agencies, pain management during labor and delivery is insufficient due to the hurdles imposed by the health system, and also to the misconceptions regarding epidural analgesia among patients, but worse still, among nurses, obstetricians and anesthesiologists.

This article mentions the point of view of outstanding international institutions on the subject, the problems that may be attributed to the health system, and the limitations imposed by specialists, emphasizing in particular the views prevailing among obstetricians and gynecologists that explain why a large proportion of women in childbirth experience pain unnecessarily.

References

1. Declaración Universal de los Derechos Humanos [consultado 12 Sep 2012]. Disponible en: http://www.un.org/es/documents/udhr/
2. Artículo 12 de la Convención sobre la eliminación de todas las formas de discriminación contra la mujer [consultado 14 Sep 2011]. Disponible en: http://www.un.org/womenwatch/daw/cedaw/text/sconvention.htm
3. Proclamación del Tratamiento del Dolor y la Aplicación de los Cuidados Paliativos como Derechos Humanos [consultado 12 Sep 2012]. Disponible en: http://www.hospicecare.com/resources/pdf-docs/proclamacion_de_panama-cf-spanish.pdf
4. Artículo 1 de la Constitución de la Organización Panamericana de la Salud consultado 3 Sep 2012. Disponible en: http://www.paho.org/spanish/d/D0_308_ch4.pdf
5. Pacto Internacional de Derechos Económicos, Sociales y Culturales (numeral 2 del artículo 10, el numeral 1 del artículo 12) [consultado 13 Sep 2011]. Disponible en: http://www2.ohchr.org/spanish/law/cescr.htm
6. Nacimientos por tipo de parto año 2012 [consultado 4 Ago 2012]. Disponible en: http://www.dane.gov.co/daneweb_V09/index.php?option=com_content&view=article&id=1806&Itemid=119
7. Duarte Ortiz G, Navarro-Vargas JR, Eslava Schmalbach J. Inequidad en el sistema de salud: el panorama de la analgesia obstétrica. Rev Colomb Anestesiol. 2013;41:215-7.
8. Chestnut DH, Vincent RD, McGrath JR, Choi WW, Bates JN.Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin? Anesthesiology. 1994;80:1193-200.
9. Chestnut DH, McGrath JM, Vincent RD. Does early administration of epidural analgesia affect obstetric outcome in nulliparous women in spontaneous labour? Anesthesiology. 1994;80:1201-8.
10. Luxman D, Wolman I, Groutz A. The effect of early epidural block administration on the progression and outcome of labor. Int J Obstet Anesth. 1998;7:161-4.
11. Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor. Does it increase the risk of caesarean section? A randomised trial. Am J Obstet Gynecol. 2006;194:600-5.
12. Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352:655-65.
13. Pan PH, Eisenach JC, The Pain of Childbirth and Its Effect on the Mother and the Fetus. En: Chestnut DH, Palley LS, Tsen LC, Wong CA, editores. Chesnut's Obsthetric Anesthesia Principles and Practice. 4.a ed. Philadelphia: MOSBY Elsevier; 2009. p. 387-400.
14. Hardy JD, Javert CT. Studies on pain: Measurements of pain intensity in childbirth. J Clin Invest. 1949;28:153-62.
15. Connelly NR, Parker RK, Pedersen T, Manikantan T, Lucas T, Serban S, et al. Diluent volume for epidural fentanyl and its effect on analgesia in early labor. Anesth Analg. 2003;96:1799-804.
16. Connelly NR, Parker RK, Lucas T, El-Mansouri M, Komanduri V, Nayak P, et al. The influence of a bupivacaine and fentanyl epidural infusion after epidural fentanyl in patients allowed to ambulate in early labor. Anesth Analg. 2001;93: 1001-5.
17. Wong CA. Epidural and Spinal Analgesia/Anesthesia for Labor and Vaginal Delivery. En: Chestnut DH, Palley LS, Tsen LC, Wong CA. Chestnut's Obstetric Anesthesia Principles and Practice. 4.a ed. Philadelphia: MOSBY Elsevier; 2009. p. 387-400.
18. Ginosar Y, Davidson EM, Firman N. A randomized controlled trial using patient-controlled epidural analgesia with 0.25% versus 0.0625% bupivacaine in nulliparous labor: effect on analgesia requirement and maternal satisfaction. Int J Obstet Anesth. 2010;19:171-8.
19. Lyons GR, Kocarev MG, Wilson RC, Columb MO. A comparison of minimum local anesthetic volumes and doses of epidural bupivacaine (0.125% w/v and 0.25% w/v) for analgesia in labor. Anesth Analg. 2007;104:412-5
How to Cite
1.
Herrera Gómez PJ, Medina PA. Problems in obstetric analgesia. Colomb. J. Anesthesiol. [Internet]. 2014 Jan. 1 [cited 2024 Feb. 28];42(1):37–39. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/623

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Published
2014-01-01
How to Cite
1.
Herrera Gómez PJ, Medina PA. Problems in obstetric analgesia. Colomb. J. Anesthesiol. [Internet]. 2014 Jan. 1 [cited 2024 Feb. 28];42(1):37–39. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/623
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