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Epidural Analgesia (epidural + analgesia)
Kinds of Epidural Analgesia Selected AbstractsThe Effect of Ultra Low Dose Epidural Analgesia on Newborn Breastfeeding BehaviorsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2003RN assistant professor, Sharon Radzyminski PhD, graduate program director Objective: To determine whether a difference in breastfeeding behaviors could be observed between newborns whose mothers received epidural analgesia for labor pain relief and those newborns whose mothers received no pain medication in labor. Design: There were two groups of neonates in this study. One group was born to mothers who received epidural analgesia, and one group was born to mothers who received no pain medication for labor. Both groups were observed for initial breastfeeding behaviors using the Premature Infant Breastfeeding Behavior Scale following birth and at 24 hours. Central nervous system functioning in the newborn was measured with the Neurologic and Adaptive Capacity Score at 2 and 24 hours of age. Setting: A large tertiary hospital in northeast Ohio. Participants: Fifty-six breastfeeding mother-newborn dyads. All mothers were healthy multiparae who gave birth vaginally to normal, full-term, healthy newborns. Main Outcome Measures: Newborns were observed for rooting, latch on, sucking, swallowing, activity state, and neurobehavior. Results: There were no statistically significant differences in breastfeeding behaviors at birth or at 24 hours of age. Conclusion: A possible cause for the lack of significant results may have been the ultra low dose of bupivacaine and fentanyl used in this sample. [source] Factors Associated with the Choice of Delivery without Epidural Analgesia in Women at Low Risk in FranceBIRTH, Issue 3 2008Camille Le Ray MD ABSTRACT: Background: Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women's characteristics, prenatal care, and type of maternity unit. Methods: The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women's choice to deliver without epidural analgesia were studied with multivariable analyses. Results: Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in nonuniversity public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site. Conclusions: Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor. (BIRTH 35:3 September 2008) [source] Combined Spinal-Epidural versus Epidural Analgesia in LabourBIRTH, Issue 1 2004D. Hughes [source] Commentary on Nystedt A., Edvardsson D. and Willman A. (2004) Epidural analgesia for pain relief in labour and childbirth , a review with a systematic approach.JOURNAL OF CLINICAL NURSING, Issue 6 2004Journal of Clinical Nursing 1 [source] Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean deliveryJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010Ching-Chung Liang Abstract Aim:, Various analgesics and administration methods are used to provide women undergoing cesarean delivery pain relief after surgery. We compared three methods of postoperative analgesia regarding the incidence of postpartum urinary retention (PUR) in primiparous women undergoing elective cesarean delivery. Methods:, We estimated post-void residual bladder volume after the first postpartum micturition among 150 parturient women. Risk factors stratified for PUR defined by 150-mL post-void residual bladder volume were analyzed. Obstetric parameters and prevalence of lower urinary tract symptoms after surgery were compared among three groups of parturient women given different postoperative analgesia: epidural bolus morphine (EBM), patient-controlled epidural analgesia (PCEA) with ropivacaine-fentanyl, and intramuscular pethidine. Results:, The incidence of PUR was higher in the group given EBM (33.3%) than the groups receiving ropivacaine-fentanyl by PCEA (15%) or intramuscular pethidine (16.7%) (P = 0.038). Eighteen (12%) parturient women needed bladder catheterization to resolve their urinary retention at 1 day postpartum but all achieved spontaneous micturition prior to hospital discharge. The need for catheterization was also increased in the group with EBM (21.7%) in comparison with the other two groups (6.7% and 3.3%, respectively, P = 0.011). At the 3-month follow up, six women (4%) had obstructive voiding problems and seven women (4.7%) had irritating voiding problems. At the 1-year follow up, only one woman in the EBM group had incomplete emptying and another in the PCEA group had urinary incontinence. Conclusion:, Epidural analgesia with morphine was significantly associated with post-cesarean urinary retention. Nonetheless, it was not detrimental to later urinary function. [source] Epidural analgesia and post-operative outcomes , a need for a different approachACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2008H. KEHLET No abstract is available for this article. [source] Epidural analgesia and compartment syndromePEDIATRIC ANESTHESIA, Issue 5 2009Suresh Chittoodan No abstract is available for this article. [source] Continuous patient-controlled epidural infusion of levobupivacaine plus sufentanil in labouring primiparous women: effects of concentration*ANAESTHESIA, Issue 6 2010S. Tixier Summary The effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg.ml,1 levobupivacaine (low concentration group) or 1.136 mg.ml,1 levobupivacaine (high concentration group), with sufentanil 0.45 ,g.ml,1 added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml.h,1. Analgesia was found to be more efficacious in the high-concentration group. The dose of levobupivacaine administered was higher and sometimes overstepping recommended limits in the high concentration group, but with no observed increase in side-effects. The choice between these two concentrations may still be made according to the patient's and the practitioner's preferences. The effects of an intermediate concentration should be studied in the future. [source] Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison groupANAESTHESIA, Issue 2 2010M. J. A. Wilson Summary We compared breastfeeding initiation and duration in 1054 nulliaparae randomised to bupivacaine Control epidural, Combined Spinal Epidural or Low Dose Infusion and 351 matched non-epidural comparisons. Women were interviewed after delivery and completed a postal questionnaire at 12 months. Regression analysis determined factors which independently predicted breastfeeding initiation. Breastfeeding duration was subjected to Kaplan,Meier analysis. A similar proportion of women in each epidural group initiated breastfeeding. Women with no epidural did not report a higher initiation rate relative to epidural groups and those who received pethidine reported a lower initiation rate than control epidural (p = 0.002). Older age groups (p < 0.001) and non-white ethnicity (p < 0.026) were predictive of breastfeeding. Epidural fentanyl dose, delivery mode and trial group were not predictive. Mean duration for breastfeeding was similar across epidural groups (Control 13.3, Combined Spinal Epidural 15.5, Low Dose Infusion 15.0 weeks). Our data do not support an effect of epidural fentanyl on breastfeeding initiation. [source] Epidural analgesia: first do no harmANAESTHESIA, Issue 1 2008J. Low No abstract is available for this article. [source] Factors Associated with the Choice of Delivery without Epidural Analgesia in Women at Low Risk in FranceBIRTH, Issue 3 2008Camille Le Ray MD ABSTRACT: Background: Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women's characteristics, prenatal care, and type of maternity unit. Methods: The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women's choice to deliver without epidural analgesia were studied with multivariable analyses. Results: Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in nonuniversity public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site. Conclusions: Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor. (BIRTH 35:3 September 2008) [source] Epidural versus Non-Epidural or No Analgesia in LabourBIRTH, Issue 1 2006Article first published online: 28 JUN 200 A substantive amendment to this systematic review was last made on 16 August 2005. Cochrane reviews are regularly checked and updated if necessary. Abstract Background:, Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. Objectives:, To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2005). Selection criteria:, Randomised controlled trials comparing all modalities of epidural with any form of pain relief not involving regional blockade, or no pain relief in labour. Data collection and analysis Two of the review authors independently assessed trials for eligibility, methodological quality and extracted all data. Data were entered into RevMan and double checked. Primary analysis was by intention-to-treat; sensitivity analyses excluded trials with >30% of women receiving un-allocated treatment. Main results:, Twenty-one studies involving 6664 women were included, all but one study compared epidural analgesia with opiates. For technical reasons, data on women's perception of pain relief in labour could only be included from one study, which found epidural analgesia to offer better pain relief than non-epidural analgesia (weighted mean difference (WMD),2.60, 95% confidence interval (CI),3.82 to ,1.38, 1 trial, 105 women). However, epidural analgesia was associated with an increased risk of instrumental vaginal birth (relative risk (RR) 1.38, 95% CI 1.24 to 1.53, 17 trials, 6162 women). There was no evidence of a significant difference in the risk of caesarean delivery (RR 1.07, 95% CI 0.93 to 1.23, 20 trials, 6534 women), long-term backache (RR 1.00, 95% CI 0.89 to 1.12, 2 trials, 814 women), low neonatal Apgar scores at 5 minutes (RR 0.70, 95% CI 0.44 to 1.10, 14 trials, 5363 women), and maternal satisfaction with pain relief (RR 1.18 95% CI 0.92 to 1.50, 5 trials, 1940 women). No studies reported on rare but potentially serious adverse effects of epidural analgesia. Authors' conclusions:, Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes. Citation:, Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD000331.pub2. DOI: 10.1002/14651858.CD000331.pub2. *** The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1465,1858). Abstracts of Cochrane reviews are compiled and produced by Update Software Ltd on behalf of the publisher, John Wiley & Sons Ltd. [source] The changing face of epidural analgesiaEQUINE VETERINARY EDUCATION, Issue 11 2007C. Trim No abstract is available for this article. [source] Lumbosacral spinal cord somatosensory evoked potentials for quantification of nociception in horsesEQUINE VETERINARY JOURNAL, Issue 3 2010J. P. A. M. Van LOON Summary Reasons for performing study: There is a need for objective evaluation and quantification of the efficacy of analgesic drugs and analgesic techniques in horses. Objectives: To determine whether lumbosacral spinal cord somatosensory evoked potentials (SSEP) can be a useful and reliable tool to assess nociception in equines. Methods: SSEPs and electromyograms (EMG) from the epaxial muscles were recorded simultaneously, following electrical stimulation applied to the distal hindlimb in lightly anaesthetised Shetland ponies (n = 7). In order to validate the model, the effect of increasing stimulus intensity was documented and the conduction velocities (CV) of the stimulated nerves were calculated. The effect of epidurally applied methadone (0.4 mg/kg bwt) in a randomised, crossover design was investigated. Results: Two distinct complexes (N1P1 and N2P2) were identified in the SSEP waveform. Based on their latency and conduction velocity and the depressant effect of epidurally applied methadone, the SSEP N2P2 was ascribed to nociceptive A,-afferent stimulation. The SSEP N1P1 originated from non-nociceptive A,-afferent stimulation and was not influenced by epidurally applied methadone. Conclusions and potential relevance: The nociceptive A, component of the SSEP, the N2P2 complex, is presented as a valid and quantitative parameter of spinal nociceptive processing in the horse. Validation of the equine SSEP model enables the analgesic effects of new analgesics/analgesic techniques to be quantified and analgesia protocols for caudal epidural analgesia in equidae improved. [source] On the ropivacaine-reducing effect of low-dose sufentanil in intrathecal labor analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010C. M. ORTNER Background: Combining ropivacaine with sufentanil for intrathecal (i.t.) analgesia in labor is well recognized, but information on dosing is limited. This study aimed to determine the ED 50 of i.t. ropivacaine and to assess the effect of adding defined low doses of sufentanil. Methods: This was a two-phase, double-blind, randomized and prospective study. One hundred and fifteen parturients receiving combined spinal epidural analgesia were allocated to one of four groups to receive ropivacaine or sufentanil alone or in combination. In phase one, sufentanil dose,response was calculated using logistic regression. In phase two, ED 50 of ropivacaine and of the combination with a fixed dosage of sufentanil at ED 20 and ED 40 was evaluated using the technique of up,down sequential allocation. Analgesic effectiveness was assessed 15 min after injection using a 100 mm visual analog scale, with <10 mm lasting for 45 min defined as effective. Furthermore, side effects and duration were recorded. Results: The ED 50 of i.t. ropivacaine was 4.6 mg [95% confidence intervals (95% CI) 4.28, 5.31]. Adding sufentanil at ED 20 significantly decreased the ED 50 of i.t. ropivacaine to 2.1 mg (95%CI 1.75, 2.5) (P<0.005); at ED 40, the reduction was similar (P<0.005). Combining sufentanil with ropivacaine resulted in a dose-independent prolongation of analgesia. Besides pruritus, which was well tolerated, there were no differences in side effects. Conclusion: Adding sufentanil at ED 20 results in a more than 50% dose-sparing effect of ropivacaine and considerably prolongs analgesia. Increasing dosage implicates no clinical benefit. [source] The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009J. E. CHO Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children. Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivacaine 1.5 mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded. Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all P<0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P=0.010). Conclusion: The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl. [source] Post-operative epidural analgesia: introducing evidence-based guidelines through an education and assessment processJOURNAL OF CLINICAL NURSING, Issue 2 2001DipDN, Janet Richardson BSc ,,The aim of this project was to re-introduce post-operative epidural analgesia on to two orthopaedic wards using an evidence-based practice approach. This was achieved through the provision of appropriate staff education and information, assessment of staff competence, and provision of relevant and appropriate staff support. ,,An education programme was developed which included study days, ward-based teaching and the assessment of competence. ,,The introduction of guidelines followed an audit cycle in order to measure the success of the education programme. ,,All nursing staff involved in the project were asked to complete a questionnaire which assessed their knowledge of caring for patients with postoperative epidural analgesia. This was completed before and following the education programme. ,,The outcome measures were: (i) successful completion of competence-based assessment; (ii) levels of knowledge as assessed by the knowledge questionnaire; and (iii) participant perceptions of the project. ,,The results of the questionnaire demonstrated significant improvements in knowledge following the education programme. Participants commented on the importance of the ward-based teaching. They also felt that pain was controlled more effectively using this method of analgesia. [source] Analgesia for labour: a survey of Norwegian practice , with a focus on parenteral opioidsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009T. O. TVEIT Background: During the last two decades, epidural analgesia has become ,a gold standard' for labour pain in most Western countries. Newer short-acting opioids given systemically represent an alternative for adequate pain relief without using regional techniques. With this survey, we wish to explore how Norwegian hospitals practice labour analgesia, especially their use of systemic opioids. Methods: A questionnaire was sent to the head of all 46 registered Norwegian labour units in 2005. The questionnaire focused on epidural and the use of systemic opioids. In 2008, the same questionnaire was sent to the 19 largest units reporting >1000 births a year, seeking updated information. Results: Forty-three of the 46 original questionnaires were returned. An epidural frequency of 25.9% was registered. For epidural treatment, bupivacaine was the preferred local anaesthetic, while sufentanil was the opioid of choice for the majority of units. Pethidine was the most commonly used opioid for systemic administration (77%). All units reported nurse administration of systemic opioids. The intramuscular route was most commonly used, either alone (58%) or in combination with an intravenous (i.v.) administration (34%). Only one unit used i.v. fentanyl. There were only minor changes with the repeated survey, except for one large unit, which reported over a 50% increase in the epidural frequency. Conclusion: In Norway, the frequency of epidural for labour analgesia is still relatively low, but seems to be increasing. Systemic opioids are often used instead of or as a supplement. Clinical practice seems to be conservative, and newer short-acting opioids are seldom used systemically. [source] Does thoracic epidural analgesia improve systolic and diastolic functions by improved myocardial oxygenation in patients with coronary artery disease?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009S.-E. RICKSTEN No abstract is available for this article. [source] High thoracic epidural analgesia improves left ventricular function in patients with ischemic heartACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009C.-J. JAKOBSEN Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease. Methods: The effect of a high epidural block (at least Th1,Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E,) and atrial (A,) peak velocities during diastole. Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 ± 1.53 to 6.86 ± 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E,/A, ratio increased from 0.75 ± 0.27 to 1.09 ± 0.32 (P=0.0026), indicating improved relaxation. Conclusion: A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease. [source] Walking reduces the post-void residual volume in parturients with epidural analgesia for labor: a randomized-controlled studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009C. F. WEINIGER Background: The post-void residual volume is higher among parturients who received epidural analgesia than those who received no or alternative analgesia. Methods: This prospective, randomized, controlled, non-blinded study was performed in a tertiary referral center labor suite. The post-void residual volume was measured by a transabdominal ultrasound following a voiding attempt. Healthy parturients with low-dose epidural analgesia in active labor were randomized either to walk to the toilet or to use a bedpan for voiding. The primary outcome measure (post-void residual volume in labor) was compared between the study groups. Results: The toilet group (n=34) and the bedpan group (n=28) demonstrated similar post-void residual volumes (212 ± 100 vs. 168 ± 93 ml, P=0.289). Twenty patients (59%) randomized to the toilet group were unable to walk and actually voided in a bedpan. A secondary analysis was performed analyzing the groups as treated. The post-void residual volume was significantly lower in the actual toilet group (n=14, 63 ± 24 ml) vs. the bedpan group (n=48, 229 ± 200 ml), P=0.0052. Thirteen (93%) women who walked to the toilet managed to void before the ultrasound measurement vs. 20/48 (42%) using the bedpan, P=0.001. Fewer women who managed to walk to the toilet required urinary bladder catheterization during the labor than women who used the bedpan (6/14, 43% vs. 36/48, 75%) P=0.028. Conclusion: Women who were randomized to walk to the bathroom with epidural analgesia and were able to do so during labor had a significantly reduced post-void residual volume and a reduced requirement for urinary catheterization. [source] Continuous lumbar epidural infusion of levobupivacaine: effects of small-or large-volume regimen of infusionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009G. DANELLI Background: The question of whether the dose, concentration or volume of a local anesthetic solution is the relevant determinant of the spread and quality of post-operative epidural analgesia is still open. In this prospective, randomized, double-blind study, we compared the effects of a large volume,low concentration with a small-volume,high-concentration lumbar epidural infusion of levobupivacaine. Methods: Seventy patients scheduled for total hip replacement were enrolled. After surgery, patients were randomly allocated to receive a continuous epidural infusion of levobupivacaine (10.5 mg/h) using either 0.125% levobupivacaine infused at 8.4 ml/h (low concentration group, n=35) or 0.75% levobupivacaine infused at 1.4 ml/h (high concentration group, n=35). We blindly recorded the degree of pain relief at rest and during movement every 8 h for the first two post-operative days, as well as hip flexion, motor block, rescue analgesic consumption and adverse events. Results: No difference in pain relief was observed between groups as estimated with the areas under the curve of the verbal Numerical Rating Scale for pain over time, both at rest and during movement. Similarly, there was no difference between groups in hip flexion degree, motor blockade and hemodynamic stability. Conclusions: Continuous lumbar epidural infusion of 0.75% levobupivacaine was as effective as continuous lumbar epidural infusion of 0.125% levobupivacaine, when administered at the same hourly dose of 10.5 mg, in achieving adequate analgesia both at rest and during movement, without differences in the incidence of hypotension and motor blockade. [source] Hemodynamic changes during vaginal delivery in a parturient with no labor painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009E. LANGESÆTER This is the case of a 35-year-old woman who had an induction for vaginal delivery because of severe pre-eclampsia. This case demonstrates the hemodynamic changes during the second stage of labor in a patient with epidural analgesia and complete pain relief during delivery. [source] The Effect of Ultra Low Dose Epidural Analgesia on Newborn Breastfeeding BehaviorsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2003RN assistant professor, Sharon Radzyminski PhD, graduate program director Objective: To determine whether a difference in breastfeeding behaviors could be observed between newborns whose mothers received epidural analgesia for labor pain relief and those newborns whose mothers received no pain medication in labor. Design: There were two groups of neonates in this study. One group was born to mothers who received epidural analgesia, and one group was born to mothers who received no pain medication for labor. Both groups were observed for initial breastfeeding behaviors using the Premature Infant Breastfeeding Behavior Scale following birth and at 24 hours. Central nervous system functioning in the newborn was measured with the Neurologic and Adaptive Capacity Score at 2 and 24 hours of age. Setting: A large tertiary hospital in northeast Ohio. Participants: Fifty-six breastfeeding mother-newborn dyads. All mothers were healthy multiparae who gave birth vaginally to normal, full-term, healthy newborns. Main Outcome Measures: Newborns were observed for rooting, latch on, sucking, swallowing, activity state, and neurobehavior. Results: There were no statistically significant differences in breastfeeding behaviors at birth or at 24 hours of age. Conclusion: A possible cause for the lack of significant results may have been the ultra low dose of bupivacaine and fentanyl used in this sample. [source] Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean deliveryJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010Ching-Chung Liang Abstract Aim:, Various analgesics and administration methods are used to provide women undergoing cesarean delivery pain relief after surgery. We compared three methods of postoperative analgesia regarding the incidence of postpartum urinary retention (PUR) in primiparous women undergoing elective cesarean delivery. Methods:, We estimated post-void residual bladder volume after the first postpartum micturition among 150 parturient women. Risk factors stratified for PUR defined by 150-mL post-void residual bladder volume were analyzed. Obstetric parameters and prevalence of lower urinary tract symptoms after surgery were compared among three groups of parturient women given different postoperative analgesia: epidural bolus morphine (EBM), patient-controlled epidural analgesia (PCEA) with ropivacaine-fentanyl, and intramuscular pethidine. Results:, The incidence of PUR was higher in the group given EBM (33.3%) than the groups receiving ropivacaine-fentanyl by PCEA (15%) or intramuscular pethidine (16.7%) (P = 0.038). Eighteen (12%) parturient women needed bladder catheterization to resolve their urinary retention at 1 day postpartum but all achieved spontaneous micturition prior to hospital discharge. The need for catheterization was also increased in the group with EBM (21.7%) in comparison with the other two groups (6.7% and 3.3%, respectively, P = 0.011). At the 3-month follow up, six women (4%) had obstructive voiding problems and seven women (4.7%) had irritating voiding problems. At the 1-year follow up, only one woman in the EBM group had incomplete emptying and another in the PCEA group had urinary incontinence. Conclusion:, Epidural analgesia with morphine was significantly associated with post-cesarean urinary retention. Nonetheless, it was not detrimental to later urinary function. [source] A Survey of the Current Practice of Obstetric Anaesthesia and Analgesia in MalaysisJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2000Dr. Y. K. Chan Abstract Objective: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996. Results: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all. Conclusions: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom. [source] Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007B. C. H. Tsui Background:, Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods:, After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1,10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2,8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results:, Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4,7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion:, This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization. [source] Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006P. Hannemann Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source] Can chronic poststernotomy pain after cardiac valve replacement be reduced using thoracic epidural analgesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2004M. K. Jensen Background:, The aim of our study was to evaluate the use of thoracic epidural analgesia (TEA) in acute pain management after cardiac valve replacement and determine if the incidence of chronic pain related to the sternotomy was reduced by the use of TEA. This patient group was chosen to exclude pain related to the use of the internal mammary artery and angina pectoris. Methods:, Patients scheduled for elective cardiac valve replacement were offered TEA. A match-control group was selected. Epidural catheter placement, complications and postoperative neurological state were noted for both groups. Eighteen months postoperatively, a questionnaire was sent out concerning pain management, wound discomfort and pain. Results:, Forty-nine patients were included. The TEA group consisted of 35 patients. At 18 months' follow up, 37% from the TEA group and 21% from the control group had pain or discomfort related to the sternum (NS). Two in the TEA group had severe pain. Conclusion:, We found in our small material that TEA provided excellent analgesia in the peri- and postoperative period, but we did not find a protective effect of TEA on chronic poststernotomy pain, neither weak pain nor severe pain. [source] Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus techniqueACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2004P. Halonen Background:, We tested the hypothesis that patient-controlled epidural analgesia for labor (PCEA) provides better analgesia and satisfaction than the intermittent bolus technique (bolus) without affecting the mode of delivery. Methods:, We randomized 187 parturients to receive labor analgesia using either the PCEA or bolus technique. The PCEA group received a starting bolus of 14 mg of bupivacaine and 60 µg of fentanyl in a 15-ml volume, followed by a background infusion (bupivacaine 0.08% and fentanyl 2 µg ml,1) 5 ml h,1 with a 5-ml bolus and 15-min lock-out interval. The bolus group received boluses of 20 mg of bupivacaine and 75 µg of fentanyl in a 15-ml volume. Results:, Parturients in the PCEA group had significantly (P < 0.05,0.01) less pain during the first and second stages of labor. There was no difference in the spontaneous delivery rate between the groups, but the cesarean delivery rate was significantly (P < 0.05) higher (16.3% vs. 6.7%) in the PCEA group than in the bolus group. Bupivacaine consumption was significantly (P < 0.01) higher (11.2 mg h,1 vs. 9.6 mg h,1) and the second stage of labor was significantly (P < 0.01) longer (70 min vs. 54 min) in the PCEA group than in the bolus group. Patient satisfaction was equally good in both groups. Conclusion:, The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section. [source] | |||||||||||||||||||||||||||||||