Speakers - 2026

Title: Differentiated approach and rationale for methods of neuraxial analgesia in labor

Abstract

Birth pain is consistently among the most severe types of pain that a woman experiences during her life. Even a small prevalence of persistent pain after childbirth has important consequences for public health and a great social burden. The use of neuroaxial techniques such as combined spinal-epidural anesthesia (CSEA) or epidural analgesia with puncture of the dura mater (DPE) may have advantages over standard EA. One of the methods for assessing the condition of the fetus and uteroplacental blood flow in childbirth is tissue oximetry, based on the principle of near-infrared spectroscopy (NIRS). Currently, there is insufficient data on the assessment of uteroplacental blood flow using near-infrared spectroscopy, and further study using this technology may make it possible to determine the advantages and disadvantages of various methods of labor anesthesia.

The purpose of this study was to evaluate the uteroplacental blood flow by tissue oximetry, the effectiveness of pain relief and the effect on the condition of a woman in labor through the natural birth canal using EA, CSEA, and DPE
The objective was to evaluate the utero-placental blood flow using the method of tissue oximetry, the effectiveness of pain syndrome relief and the influence on the condition of the woman in labor through the natural childbirth when using epidural (EA), combined spinal-epidural (CSE) and dural puncture epidural anesthesia (DPE).

A prospective study involving 240 patients during emergency deliveries was conducted at the at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia. Analgesia was carried out by EA (N=60), CSE (N=60) and DPE (N=60), the control group consisted of women with no pain relief (N=60). On 1, 3, 5, 7, 10, 15, 25, 30, 60, 90 and 120th minutes, data from parainfrared spectroscopy (NIRS), pain from VAS, bloop pressure, respiratory rate, and oxygenation of the blood were assessed.

We have not seen NIRS decrease below 89% for either EA or CSE. All of methods (EA, CSE, DPE) provided effective, fast-onset and long-term anesthesia to the birth, manifested by statistically significant reduction of the severity of pain syndrome on VAS from 8 points to 1-3 points. The fastest analgesic effect was observed in the CSE group (1-3 min), then in the DPE group (3-10 min) and in the EA group (7-15 min). Reduction of pain severity was more significant in DPE (up to 1-2 points in VAS) compared to EA. The reduction of pain syndrome in CSE was more stable and lasting than in EA. The anesthesia methods used to have a high favorable safety profile, as blood pressure, heart rate and respiratory rate, as well as oximetry and oxygenation of the blood during the entire observation period were within normal values.

What will the audience take away from presentation?

• The audience will be introduced to modern and safe labor pain relief techniques in Russia.
• Their main advantages and features will be demonstrated.
• Our own data on their impact on the mother, fetus, and newborn will be presented.
• We will present our own algorithm for choosing a labor pain relief technique based on the initial characteristics of the mother and fetus.
• The presented data can be used in practical obstetrics to select the optimal method of pain relief during labor depending on the initial needs and parameters of the mother and fetus, with the aim of increasing the safety and effectiveness of pain relief for women in labor and achieving maximum satisfaction with the birth process.
• The presented algorithm for selecting a labor pain relief technique will improve labor outcomes, reduce the incidence of complications, and increase patient satisfaction. These techniques can be used to train physicians and select the appropriate technique based on safety and effectiveness for each patient. The presented algorithm and the techniques used will improve the effectiveness of care for pregnant women in general and, in particular, by providing a personalized approach and reducing the risk of complications for both the mother and the fetus and newborn.