الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The ideal labour analgesic technique should dramatically reduce the pain of labour, while allowing the parturient to actively participate in the birthing experience. In addition, it should have minimal effect on the fetus or the progress of labour.
Safety is the first and foremost goal of obstetric anesthesia. For labour analgesia, a secondary goal is to minimize or eliminate maternal lower extremity muscle weakness.
Of all the possible methods of pain relief which can be used in labour, neuraxial blockade provides the most effective and least depressant analgesia.
Lumbar epidural analgesia provides excellent pain relief and the ability to extend the duration of block to match the duration of labour, but there are a number of problems that have prompted some to seek alternative techniques.
Efforts to improve epidural analgesia led to popularizing the combined spinal- epidural technique for analgesia in labour. This technique involved an initial intrathecal injection of opioids and local anaesthetics to establish analgesia. In absence of motor weakness, there is no functional impairment of balance after CSE analgesia in labouring women and therefore ambulation is safe.
Using CSE in advanced labour many parturients may deliver during the spinal component of the CSE technique. Single shot spinal analgesia is rapid and simple, but associated with limited duration of action.
The popularity of intrathecal opioids for the management of labour pain has increased markedly in recent years. Advantages that have been ascribed to this technique versus conventional epidural labour analgesia include more rapid onset, better analgesia, greater patient satisfaction, no motor block, and greater reliability.
In an effort to improve quality of labour analgesia and its duration, particularly in the later part of the first stage of labour, when the intensity of pain increases and the quality of the pain changes to assume a greater somatic component. The use of intrathecal fentanyl for labour analgesia has been reported in combination with local anesthetics and other opioids. Indeed, synergism between these two groups of drugs has been demonstrated.