PROMISING NONNARCOTIC ANALGESIC TECHNIQUES FOR LABOR

Epidural analgesia and spinal analgesia are the most effective techniq ues for relieving labour pain. Basically, local anaesthetics (i.e. bup ivacaine) and opioids (i.e. fentanyl or sufentanil), especially when c ombined, produce excellent analgesia with minimal motor blockade. Howe ver, none of these agents is devoid of side-effects and analgesia rema ins sometimes imperfect, suggesting that new drugs would be welcome. A drenalin and clonidine act on a(2)-adrenoceptors in the spinal cord an d both have been found to improve analgesia. These two drugs have alre ady been used in many patients and studies because the absence of neur otoxicity has been well documented. Clonidine looks more attractive, a lthough sedation and hypotension limit its use. Other analgesic drugs are promising alternatives but are still at an experimental or very ea rly clinical stage. Neostigmine and ketamine (without preservative) ar e not neurotoxic while midazolam neurotoxicity is still controversial. Intravenous remifentanil might prove useful when neuraxial analgesia is contraindicated.