Pain management for labor and delivery in the 90s

Although variable, labor pain is among the most severe of pain syndromes, and has been described as severe to excruciating in 50 to 70 percent of primiparas. "Twilight sleep" or amnesia was commonly used in the first half of this century via potent intramuscular, intravenous and inhalational agents. Subsequently, epidural anesthesia, first caudal then lumbar was used which offered superior pain relief without clouding the sensorium. However, epidurals with local anesthetics also contributed to dense sensory and motor blocks which are not necessary for labor. Presently, both spinal and epidural opioids are used along with decreasing doses of local anesthetics, rendering the laboring patient a relatively pain-free labor but allowing her more mobility and control of her environment.