Regional analgesia and anaesthesia in obstetrics

Bonica, in the mid-forties, realized the importance of providing safe analgesia and anaesthesia for parturients. In 1947, he developed the first obstetrical anaesthesia service in the world to provide continuous analgesia and anaesthesia care to these patients [1]. The need of proper pain control during parturition, which John Bonica perceived through his clinical observation and acumen, was confirmed several decades later by the research of Melzack. In 1994, Melzack published a study which demonstrated that, in the majority of women, the pain associated with parturition is more intense than neoplastic pain and pain secondary to a bone fracture [2]. This paper also brought to the forefront a concept seldom understood by most physicians. The assessment of the intensity of pain is often overlooked by clinicians and until they realize the enormous difference existing between tolerable and intolerable pain as rated by each individual patient, pain will continue to be inappropriately treated. For instance, when we speak of labor analgesia the aim is not to produce a completely pain-free parturition, but to reduce the pain to an acceptable level. A proper level of analgesia will allow the mother to actively participate in the labor while being spared the atrocity of uncontrolled, intolerable pain.