• Ban Leong Sng and Sia Alex Tiong Heng ATH Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore..
• Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore. Electronic address: sng.ban.leong@singhealth.com.sg.
• Best Pract Res Clin Anaesthesiol. 2017 Mar 1; 31 (1): 15-22.

AbstractNeuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia. We also review the newer interactive techniques for drug delivery, such as computer-integrated patient-controlled epidural analgesia and variable frequency automated mandatory bolus. Finally, we discuss future clinical research developments, including the use of data analytics and long-term outcomes associated with childbirth pain management.Copyright © 2017 Elsevier Ltd. All rights reserved.

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