Advances in neuraxial blocks for labor analgesia: new techniques, new systems

Neuraxial block for labor analgesia is widely accepted and highly effective. Much progress has been achieved in terms of providing safer and more efficacious analgesia. Emphasis has been placed on maternal autonomy and individualization of therapy. The introduction of the combined spinal-epidural technique in the labor ward has afforded excellent rapid onset analgesia and minimal impediment to maternal mobility. Newer enantiopure amide local anesthetics, like ropivacaine and levobupivacaine, have also been introduced to enhance the safety of epidural analgesia with respect to cardiotoxicity. The introduction of the computer-assisted approach to provide a more interactive background infusion could potentially refine the delivery of patient-controlled epidural analgesia. The enhanced effectiveness of synchronized basal automated boluses has also been exploited for patient-controlled epidural analgesic systems. The quest to provide seamless analgesia that empowers the laboring parturient in a cost effective way continues to be a developing area of research.