Alternatives to neuraxial analgesia for labor.

PURPOSE OF REVIEW: Although millions of parturients profit from neuraxial analgesia for labor, there are far more of those who do not have this choice for one reason or another. They need alternative ways to relieve labor pain.

RECENT FINDINGS: Paracervical block gives less efficient analgesia compared with single-shot spinal in a sample of multiparae at active labor but is associated with better umbilical artery pH. Use of a neurostimulator may increase success in pudendal block. It is possible to reduce nitrous oxide occupational exposure by a developed scavenging system. Intravenous remifentanil gives less efficient pain relief than epidural analgesia. The maternal satisfaction, however, may be comparable.

SUMMARY: Paracervical block with modern technique is a viable option for selected cases. It is rapid and does not affect the course of labor, but its efficacy is only modest. Pudendal block can be used in the second stage of labor or for episiotomy tear repair and pain. Intravenous remifentanil is currently becoming an established method, although its safety is still an issue. Nitrous oxide is a useful method to be used alone or together with the other methods.