Local Anesthetics and Adjuvants for Labor: Local Anesthetic Systemic Toxicity

Abstract

The choice of drugs used during labor is almost as important as the analgesic technique selected since effective pain relief contributes directly to satisfaction: the better the pain relief, the higher the satisfaction. Although bupivacaine has traditionally been the most widely used local anesthetic, L-bupivacaine and ropivacaine have similar action profiles with a lower risk of cardiovascular and neurologic toxicity and especially less motor blockade, when used under low-concentration strategies. The use of adjuvants, especially opioids, allows us to improve the analgesic quality while reducing the total dose of local anesthetics, although their use should be individualized, and patients should be monitored and treated for side effects if they appear.