Safety issues of neuraxial analgesia for labor

Abstract

 As more parturients request labor analgesia, more delivery facilities introduce labor analgesia. Neuraxial analgesia is the method of analgesia for labor. This review focuses on safety issues in neuraxial analgesia for labor.

 The most serious complications for the mother include high spinal anesthesia, local anesthetic systemic toxicity（LAST）, and epidural hematoma. Analgesia providers must take preventive measures against these complications. In order to prevent high spinal anesthesia and local anesthetic systemic toxicity, aspiration before injecting each dose of local anesthetic is useful. More importantly, analgesia provider should inject no more than 2-3 mL of local anesthetic as a single bolus and watch for early signs of high spinal anesthesia and LAST. Neuraxial analgesia should not be offered to parturients with coagulopathy in order to avoid epidural hematoma. If respiratory arrest occurs due to high spinal anesthesia, mask ventilation is mandatory.

 This review also discusses other complications and side effects of neuraxial analgesia, such as post-dural puncture headache, neurological damage, effects on labor progress, maternal fever, and effects on the neonate.