The long-term benefits and risks of neuraxial analgesia in labor
Neuraxial analgesia remains the gold standard for pain relief in labor, providing effective and well-tolerated analgesia. A recent review by Kearns, Broom, and Lucas explores the potential long-term effects of neuraxial analgesia on mothers and their children, offering reassurance and guidance on managing potential complications.
The review highlights that while short-term side effects like pruritus and urinary retention are generally benign, unintentional dural puncture (UDP) can lead to more serious issues such as postdural puncture headache (PDPH). PDPH can be associated with long-term complications, including chronic headaches, back pain, and depression. It emphasizes the importance of promptly recognizing and managing PDPH to mitigate these risks. Labor epidural analgesia is not linked to long-term conditions such as chronic backache, postnatal depression, or anal sphincter injury. On the contrary, epidural analgesia may protect against severe maternal morbidity, especially in high-risk women. Moreover, the study found no connection between epidural use during labor and the development of autism spectrum disorder (ASD) in children. Maternal fever related to epidural use remains an area of uncertainty (Fig-1), necessitating further research to understand its implications for neonatal outcomes.
Fig-1. Potential mechanisms contributing to epidural-related maternal fever: noninfectious immunomodulation and altered thermoregulation.
The review highlights the need for adequate follow-up care for women who experience complications like PDPH and advocates for comprehensive consent discussions that include the potential long-term effects of neuraxial analgesia. In summary, these findings suggest that women can continue to benefit from neuraxial analgesia during labor without undue concern for long-term adverse effects. Preventative measures, proper management, and adequate follow-up are essential to ensure the best outcomes for mothers and their children.
To read the full paper in Current Opinion in Anaesthesiology, copy-paste this into your Google search:
Kearns RJ, Broom MA, Lucas DN. Long-term effects of neuraxial analgesia. Curr Opin Anaesthesiol. 2024;37(3):227-233.
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