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Epidural in labor

Angélica de Fátima de Assunção Braga, Vanessa Henriques Carvalho, Franklin Sarmento da Silva Braga, Rosa Inês Costa Pereira
INTRODUCTION: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. METHODS: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 centimeters, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII)...
September 12, 2018: Revista Brasileira de Anestesiologia
Molly E Brinser, David L Seng, Gordon L Mandell, Jonathan Waters, Patricia L Dalby, Grace Lim
STUDY OBJECTIVE: To examine the relationship between neuraxial morphine exposure after unintentional dural puncture and the risk for postdural puncture headache in obstetric patients. DESIGN: Retrospective cohort study. SETTING: Obstetrical unit at a tertiary care referral center. PATIENTS: Parturients receiving labor epidural analgesia with recognized unintentional dural puncture. INTERVENTIONS: Cases in which neuraxial morphine was given for any reason were compared to cases in which it was not for the outcome of postdural puncture headache...
September 11, 2018: Journal of Clinical Anesthesia
Ann E Sprague, Dana Sidney, Elizabeth K Darling, Vicki Van Wagner, Bobbi Soderstrom, Judy Rogers, Erin Graves, Doug Coyle, Amanda Sumner, Vivian Holmberg, Bushra Khan, Mark C Walker
INTRODUCTION: In 2014, Ontario opened 2 stand-alone midwifery-led birth centers. Using mixed methods, we evaluated the first year of operations for quality and safety, client experience, and integration into the maternity care community. This article reports on our study of safety and quality of care. METHODS: This descriptive evaluation focused on women admitted to a birth center at the beginning of labor. For context, we matched this cohort (on a 1:4 basis) with similar low-risk midwifery clients giving birth in a hospital...
September 10, 2018: Journal of Midwifery & Women's Health
Michael M Aziz, Ankita Kulkarni, Leena Shah, Susan Lashley, Yinka Oyelese
The urine protein to creatinine ratio (PC) is a sensitive and specific means of diagnosing preeclampsia in the antepartum period, but the 0.3 g protein per gram of creatinine threshold may be non-specific postpartum due to physiologic proteinuria after delivery. The objective of this study was to examine the reliability of PC in labor and postpartum and to determine if PC is affected by mode of delivery. This is the first study of its kind to examine physiologic proteinuria by catheterized PC in individual patients before and after delivery...
July 2018: Pregnancy Hypertension
Y de Jamblinne, E Baudoux, C Delo, Y Coppieters
OBJECTIVES: There is a correlation between the success of the cord blood transplant and the numbers of HSC found in the unit of cord blood donation. The purpose of this analysis is to identify obstetric factors that may influence the quality of a cord blood unit taken during delivery. METHODS: A retrospective study was carried out at the Liège cord blood bank on a sample of 7.463 cord blood units collected between 2000 and 2016. Eight obstetric factors were analyzed in relation to two dependent variables; the total nucleated cells (TNC) and the volume of one unit of cord blood...
August 16, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Yin-Fa Zhang, Fei Xiao, Wen-Ping Xu, Lin Liu
BACKGROUND: Phenylephrine infusion to prevent spinal-induced hypotension can attenuate cephalic spread of intrathecal bupivacaine. Therefore, we suspected the intrathecal dose requirement for bupivacaine may differ when using phenylephrine infusion to prevent spinal-induced hypotension in cesarean section. We designed a prospective, randomized study to determine the ED50 of hyperbaric bupivacaine for cesarean section under combined spinal-epidural anesthesia in healthy parturients with and without prophylactic phenylephrine infusion to prevent spinal-induced hypotension...
August 2018: Medicine (Baltimore)
Yang Zhang, Qing-Rong Qin, Liang-Tu Hui
AIM: Aim of this study was to estimate the incidence of motor blocks, instrumental deliveries and cesarean deliveries with ropivacaine and fentanyl in epidural analgesia for labor and to identify factors affecting the outcomes. METHODS: Electronic databases were searched for original research papers by using appropriate medical subject heading terms and keywords. Effect sizes of individual studies were pooled under random effects model to obtain weighted overall effect size/s...
August 6, 2018: Journal of Obstetrics and Gynaecology Research
Shaul Cohen, Danielle Levin, Scott Mellender, Rong Zhao, Preet Patel, William Grubb, Geza Kiss
BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a severe and debilitating complication of unintentional dural puncture. The criterion-standard treatment for PDPH has been epidural blood patch (EBP), but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. We believe this is the first ever 17-year retrospective chart review in which we compare the effectiveness of sphenopalatine ganglion block (SPGB) to EBP for PDPH treatment in postpartum patients...
July 30, 2018: Regional Anesthesia and Pain Medicine
José María García-de-Diego, Rafael Serrano-Del-Rosal
OBJECTIVE: Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper. METHOD: The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users...
July 25, 2018: Gaceta Sanitaria
Hana Harazim, Pavel Štourač, Petr Janků, Hana Zelinková, Kamil Frank, Michal Dufek, Petr Štourač
OBJECTIVES: Multiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6-month postpartum period in MS parturients with and without obstetric anesthesia/analgesia. MATERIALS AND METHODS: We retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD-10 code G35 (MS) recorded anytime in their medical history (n = 428)...
July 25, 2018: Brain and Behavior
Giorgio Capogna, Alessandra Coccoluto, Emanuele Capogna, Angelica Del Vecchio
Background: In this study, we describe a custom-made new epidural simulator, created by modifying the inner structure of a commercially available one, in the attempt to make it adequately realistic. To validate and evaluate the realism of our device, we used the Computerized Epidural Instrument CompuFlo. Method: The Compuflo CompuFlo curves obtained from 64 experiments on the epidural simulator were compared to 64 curves obtained from a previous human study, from consecutive laboring parturients requesting epidural analgesia...
2018: Anesthesiology Research and Practice
Paweł Krawczyk, Piotr Piwowar, Kinga Sałapa, Tomasz Lonc, Janusz Andres
BACKGROUND: The optimal programmed intermittent epidural bolus regimen for labor analgesia remains unknown. Some studies indicate that better drug spread in the epidural space results from greater injection pressure; however, there is a lack of data regarding the maximum pressure generated by epidural bolus injection using different catheters and flow rates. METHODS: We evaluated the flow and pressure characteristics of 11 commonly used epidural catheters combined with 3 different infusion pumps that deliver epidural infusions according to the programmed intermittent epidural bolus regimen...
July 17, 2018: Anesthesia and Analgesia
Alexander Ioscovich, Yaara Giladi, Rivka Leah Fuica, Carolyn F Weiniger, Sharon Orbach-Zinger, Yaacov Gozal, Daniel Shatalin
BACKGROUND: Accidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating. METHODS: Following IRB approval, we conducted a national survey of the lead anesthesiologist in 23 labor and delivery rooms in Israel. Each survey inquired about medical center annual delivery volume, training program for residents, accidental dural puncture management, processing of information, and PDPH management strategies...
July 3, 2018: Acta Anaesthesiologica Scandinavica
Garg Kamakshi, Grewal Anju, Singh Tania, Gupta Priyanka, Bansal Kamya, Pruthi Gegal, Chuttani Priyanka
Introduction: Varying levels of knowledge and attitudes among parturients and physicians toward epidural analgesia result in its low utilization. We aimed to assess the knowledge, attitude, and practice of parturients, obstetricians, and anesthesiologists regarding epidural labor analgesia. Methodology: We surveyed obstetricians, anesthesiologists, and parturients availing care and later delivered at our hospital from July 1, 2017, to December 31, 2017. Knowledge, attitude, and practice regarding epidural analgesia were collected using a semi-structured predesigned questionnaire...
April 2018: Anesthesia, Essays and Researches
F Haidl, L A Rosseland, O Spigset, V Dahl
BACKGROUND: The combination of low-dose local anesthesia and lipophilic opioids such as fentanyl is established as a standard solution for labor epidural analgesia. Fentanyl increases efficacy, but may have negative effects on the neonate in terms of reduced neonatal neurologic and adaptive capacity scores and breast feeding. We hypothesized that addition of adrenaline 2 μg/mL to a solution of bupivacaine 1 mg/mL and fentanyl 2 μg/mL would reduce the systemic uptake of fentanyl, resulting in reduced serum fentanyl in the fetus at birth...
October 2018: Acta Anaesthesiologica Scandinavica
Pedro Andrade, Tomi Paananen, Robert Ciszek, Niina Lapinlampi, Asla Pitkänen
BACKGROUND: Labor intensive electroencephalogram (EEG) analysis is a major bottleneck to identifying anti-epileptogenic treatments in experimental models of post-traumatic epilepsy. We aimed to develop an algorithm for automated seizure detection in experimental post-traumatic epilepsy. NEW METHOD: Continuous (24/7) 1-month-long video-EEG monitoring with three epidural screw electrodes was started 154 d after lateral fluid-percussion induced traumatic brain injury (TBI; n = 97) or sham-injury (n = 29) in adult male Sprague-Dawley rats...
September 1, 2018: Journal of Neuroscience Methods
Maria Aparecida Dos Santos Traverzim, Sergio Makabe, Daniela Fátima Teixeira Silva, Christiane Pavani, Sandra Kalil Bussadori, Kristianne Santos Porta Fernandes, Lara Jansiski Motta
BACKGROUND: Labor pain is one of the most intense pains experienced by women, which leads to an increase in the number of women opting to undergo a cesarean delivery. Pharmacological and nonpharmacological analgesia methods are used to control labor pain. Epidural analgesia is the most commonly used pharmacological analgesia method. However, it may have side effects on the fetus and the mother. Light-emitting diode (LED) photobiomodulation is an effective and noninvasive alternative to pharmacological methods...
June 2018: Medicine (Baltimore)
V Baliuliene, A Macas, K Rimaitis
BACKGROUND: The study aim was to evaluate the efficacy and safety of different low concentrations of two local anesthetics for labor analgesia using patient-controlled epidural analgesia. METHODS: A double-blind, randomized controlled trial recruiting healthy nulliparous women was conducted from 2014 to 2017. Epidural analgesia was provided using local anesthetic and fentanyl. Patients were allocated to six groups, according to the concentration of bupivacaine or levobupivacaine (0...
August 2018: International Journal of Obstetric Anesthesia
G Capogna, M Camorcia, A Coccoluto, M Micaglio, M Velardo
BACKGROUND: This prospective study was designed to validate the CompuFlo® device and to assess its use in difficult epidural placement. METHODS: In the first part of the study, 30 parturients requesting labor epidural analgesia were recruited. The block was performed by an expert anesthesiologist, with the Tuohy needle connected to the CompuFlo® device to evaluate the agreement between the anesthesiologist's reported sensation and the variation of pressure recorded by the CompuFlo®...
May 4, 2018: International Journal of Obstetric Anesthesia
Chryssoula Staikou, Alexandros Μakris, Kassiani Theodoraki, Athanasia Τsaroucha, Amalia Douma, Eleni Μoka, Eleni Αrnaoutoglou, Tilemahos Paraskevopoulos, Ioanna Siafaka, Efi Stavropoulou, Eriphili Αrgyra
Aims: The aim of this nationwide descriptive survey was to assess the use of regional anesthesia in obstetrics in Greek public hospitals. Methods: The survey was conducted between March and August, 2016. A structured questionnaire was sent to 50 Anesthesia Departments in Greek Public Hospitals with obstetric units. Results: The response rate was 94%. Data corresponded to 9475 cesarean and 8155 vaginal deliveries. Regional anesthesia was used in 69...
June 19, 2018: Balkan Medical Journal
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