Regional anesthesia in the treatment of acute pain during labor and delivery.

Porod mnoge žene opisuju kao najbolnije iskustvo u životu, acilj je moderne medicine tu bol olakšati. Iako postoje mnoge metode ublažavanja boli, metode regionalne analgezije su najefikasnije i najčešće korištene u porodništvu. U ovom diplomskom opisane su metode regionalne analgezije koje se najučestalije koriste pri liječenju akutne boli tijekom poroda, njihove tehnike primjene, indikacije i kontraindikacije, karakteristike i komplikacije. Regionalnu analgeziju dijelimo na centralne tehnike odnosno neuroaksijalnu analgeziju i na periferne tehnike odnosno periferne živčane blokove. Neuroaksijalne metode su danas zlatni standard za ublažavanje boli tijekom poroda te su gotovo potpuno istisnule tehnike periferne analgezije (paracervikalni blok tijekom prve faze poroda i pudendalni blok tijekom druge faze poroda). Neuroaksijalnim metodama pripadaju: spinalna epiduralna i kombinirana spinalno-epiduralna analgezija. Od navedenih, epiduralna analgezija je danas najprimjenjivanija anesteziološka tehnika za ublažavanje boli u porodništvu. Ona dokazano najbolje ublažava bol tijekom prve i druge faze poroda, omogućuje rodilji aktivno sudjelovanje u porodu, dovodi do najmanje nuspojava i komplikacija, jednostavno se primjenjuje i veliko je zadovoljstvo rodilja njome. Spinalna analgezija ima prednost nad epiduralnom kada je u pitanju hitni carski rez jer dovodi do brzog nastupa anestezije koju prati duboka mišićna relaksacija. Kombinirana spinalna-epiduralna analgezija u idealnom slučaju kombinira najbolje karakteristike spinalne analgezije i epiduralne analgezije dok izbjegava njihove nedostatke. Regionalna analgezija se zasluženo smatra najboljom metodom za uklanjanje porođajne patnje te danas postaje integralni i nezamjenjivi dio procesa rađanja.Childbirth is described as life’s most painful experince by many women so modern medicine has set the goal to ease the pain of giving birth. Although there are many methods to ease the pain, regional analgesia is the most efficient and most frequently used amongst them. In this paper, I described the methods of regional analgesia that are most frequently used in treating acute pain during childbirth, their charachteristics, indications, contraindications, side effects and complications. Regional analgesia is divided into central techniques (neuroaxial analgesia) and peripheral techniques (peripheral nerve blocks). Neuroaxial methods are the gold standard for easing the pain during childbirth as they put peripheral techniques in second place (paracervical block during the first phase and pudendal block during the second phase of labor). Neuroaxial methods are: spinal, epidural and combined spinal–epidural analgesia. Amongst the listed techniques, epidural analgesia is the most frequently used anaesthetic technique in treating labor pain. It is proven to be the most efficient in easing the pain during the first and the second phase of childbirth, it enables the woman in labor to have an active role in labor and has fewer side effects and complications. It is easy to perform and women are greatly satisfied with said method. The advantage of spinal analgesia compared to epidural is the emergency c-section because the onset of analgesia is really quick and is also followed by deep muscle relaxation. The combined spinal – epidural analgesia ideally combines the best of both techniques, while avoiding their disadvantages at the same time. Regional anaesthesia is by far the best way of easing the pain during labor and nowadays it's becoming an integral and irreplaceable part of the process of giving birth