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Pain management in labor

Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
Megan Conrad, Shelby Stricker
OBJECTIVE: In the current study, we explored the relationship between a woman's personality, epidural use and perceptions of the labour and birth experience. BACKGROUND: Having a positive birthing experience is relevant to predicting a range of important outcomes including mother-infant bonding, fertility rates and delivery interventions. However, limited research has addressed the kinds of individual differences that may affect a woman's subjective birthing experience...
February 2018: Journal of Reproductive and Infant Psychology
M Werntz, R Burwick, B Togioka
BACKGROUND: Use of intraperitoneal local anesthetic to treat intraoperative pain during cesarean delivery has not been described previously. The aim of this study was to determine if intraperitoneal chloroprocaine may be useful as an adjunct to neuraxial block in reducing the proportion of patients with severe intraoperative pain that requires conversion to general anesthesia. Intraperitoneal chloroprocaine was administered during cesarean delivery as a potential alternative, when the anesthesiologist considered performing a general anesthetic due to severe intraoperative pain...
March 1, 2018: International Journal of Obstetric Anesthesia
M R Hoyt, U Shah, J Cooley, M Temple
OBJECTIVES: Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery. METHODS: We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1...
January 31, 2018: International Journal of Obstetric Anesthesia
José L Arias-Buría, Carlos Martín-Saborido, Joshua Cleland, Shane L Koppenhaver, Gustavo Plaza-Manzano, César Fernández-de-Las-Peñas
Objective: To evaluate the cost-effectiveness of the inclusion of trigger point-dry needling (TrP-DN) into an exercise program for the management of subacromial pain syndrome. Methods: Fifty patients with unilateral subacromial pain syndrome were randomized with concealed allocation to exercise alone or exercise plus TrP-DN. Both groups were asked to perform an exercise program targeting the rotator cuff musculature twice daily for five weeks. Patients allocated to the exercise plus TrP-DN group also received dry needling during the second and fourth sessions...
February 22, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Salvatore Butticè, Antonio Simone Laganà, Salvatore Giovanni Vitale, Christopher Netsch, Yiloren Tanidir, Francesco Cantiello, Laurian Dragos, Michele Talso, Esteban Emiliani, Rosa Pappalardo, Tarik Emre Sener
OBJECTIVE: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. MATERIALS AND METHODS: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS...
December 31, 2017: Archivio Italiano di Urologia, Andrologia
Julie Bonapace, Guy-Paul Gagné, Nils Chaillet, Raymonde Gagnon, Emmanuelle Hébert, Sarah Buckley
OBJECTIVE: To review the evidence relating to nonpharmacological approaches in the management of pain during labour and delivery. To formulate recommendations for the usage of nonpharmacological approaches to pain management. OPTIONS: Nonpharmacological methods available for pain management during labour and delivery exist. These should be included in the counselling and care of women. EVIDENCE: PubMed and Medline were searched for articles in French and English on subjects related to "breastfeeding," "pain," "epidural," "anaesthesia," "analgesia," "labour," "labor," and combined with "gate control theory," "alternative therapies," "massage," "position," "mobility," "TENS," "bathing," "DNIC," "acupuncture," "acupressure," "sterile water injection," "higher center," "control mind," "cognitive structuring," "holistic health," "complementary therapy(ies)," "breathing," "relaxation," "mental imagery," "visualization," "mind focusing," "hypnosis," "auto-hypnosis," "sophrology," "mind and body interventions," "music," "odors," "biofeedback," "Lamaze," "Bonapace," "prenatal training," "gymnastic," "chanting," "haptonomy," "environment," "transcutaneous electrical stimulus-stimulation," "antenatal education," "support," "continuous support," "psychosocial support," "psychosomatic medicine," "supportive care," "companion," "intrapartum care," "nurse," "midwife(ves)," "father," "doula," "caregiver," " hormones," "oxytocin," "endorphin," "prolactin," "catecholamine," "adrenaline," and "noradrenaline" from 1990 to December 2015...
February 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Homeira Vafaei, Neda Rahimirad, Seyedeh Marjan Hosseini, Maryam Kasraeian, Nasrin Asadi, Hadi Raeisi Shahraki, Khadijeh Bazrafshan
Background: Preterm labor and birth are associated with several neonatal complications including respiratory distress syndrome and intraventricular hemorrhage. Differentiating true and false labor pain is a dilemma to obstetricians. Objective: To elucidate the role of cervical length measurement in prediction of birth in pregnant women with threatened preterm labor. Materials and Methods: In this double blind randomized clinical trial, 120 women with gestational age <34 wk who presented painful uterine contractions randomly assigned to undergo measurement of cervical length...
November 2017: International Journal of Reproductive Biomedicine (Yazd, Iran)
Rajavadi Tanvisut, Kuntharee Traisrisilp, Theera Tongsong
BACKGROUND: Many strategies for labor pain management have been studied, including aromatherapy, which is a noninvasive, alternative medicine used as an adjunct for labor pain control. Nevertheless, the results were contradictory. Therefore, we conducted this study to determine the effectiveness of aromatherapy for reducing pain during labor. METHODS: A randomized controlled trial was carried out on Thai laboring primigravidae who were a low-risk singleton pregnancy undergoing vaginal delivery...
February 3, 2018: Archives of Gynecology and Obstetrics
Priscilla J Hall, Jennifer Whitman Foster, Kathryn M Yount, Bonnie Mowinski Jennings
OBJECTIVE: To explore the complexity of women's birth experiences in the context in which they occur and to describe how these influence women's well-being in labor. DESIGN: Qualitative method with a phenomenological approach, following the analysis principles of van Manen. PARTICIPANTS AND SETTING: Eight women from different ethnic and socioeconomic backgrounds in Atlanta, Georgia, United States with a recent, healthy birth were interviewed twice about their experience of the labor journey...
March 2018: Midwifery
Fayez Kheir, George Cheng, Estefania Rivera, Alejandro Folch, Erik Folch, Fernandez-Bussy Sebastian, Colleen Keyes, Mihir Parikh, Colleen Channick, Alex Chee, Adnan Majid
BACKGROUND: Treatment of pleural infection with instillation of sequential intrapleural tissue plasminogen activator (tPA) and human recombinant deoxyribonuclease (DNase) twice daily for a total of 6 doses has been shown to decrease surgical referral and improve radiographic imaging. This labor-intensive regimen was empirically chosen. Thus, it remains unclear whether the 2 drugs can be administered immediately one after the other (concurrent administration) instead of instilling them separately with a 1-hour to 2-hour interval in between (sequential administration)...
January 16, 2018: Journal of Bronchology & Interventional Pulmonology
Fatemeh Najafi, Molouk Jaafarpour, Kourosh Sayehmiri, Javaher Khajavikhan
Background: In this study, the effects of SP6 and LI4 acupressure on the pain severity and length of labor are examined. Materials and Methods: This systematic review and meta-analysis study was performed on articles published in 2004-2015. The articles, published in the English and Farsi languages, related to the effects of acupressure on the SP6 and LI4 points on the length and pain severity of labor. Data were collected by searching medical databases, including PubMed, ISI, MagIran, Google Scholar, Iran Medex, SID, Irandoc, and EMBASE, for relevant material...
January 2018: Iranian Journal of Nursing and Midwifery Research
Agani Afaya, Vida N Yakong, Richard A Afaya, Solomon M Salia, Peter Adatara, Anthony K Kuug, Flex K Nyande
Introduction: Labor and delivery process is an exciting, anxiety-provoking, but rewarding time for a woman and her family after successful delivery of a newborn. The intrapartum period is the time where mothers expect more care. Taking care of a mother through delivery with no side effects is the task of a professional midwife who is trained with the skill to take the responsibility of caring for mothers and babies. Therefore, the aim of this study was to explore mother's experiences regarding quality of intrapartum nursing/midwifery care...
December 2017: Journal of Caring Sciences
Michelle Sophie Keller, Hannah J Park, Maria Elena Cunningham, Joshua Eleazar Fouladian, Michelle Chen, Brennan Mason Ross Spiegel
BACKGROUND: Virtual reality (VR) technology provides an immersive environment that enables users to have modified experiences of reality. VR is increasingly used to manage patients with pain, disability, obesity, neurologic dysfunction, anxiety, and depression. However, public opinion regarding the use of VR in health care has not been explored. Understanding public opinion of VR is critical to ensuring effective implementation of this emerging technology. OBJECTIVE: This study aimed to examine public opinion about health care VR using social listening, a method that allows for the exploration of unfiltered views of topics discussed on social media and online forums...
December 19, 2017: Journal of Medical Internet Research
Alyssa Knox, Geneviève Rouleau, Sonia Semenic, Malisa Khongkham, Luisa Ciofani
BACKGROUND: Epidural rates are high in tertiary obstetric referral centers, even though many patients in tertiary settings might not want or need epidural analgesia. Epidural rates are influenced by factors including labor support and routine medical intervention. This study aimed to identify barriers and facilitators to birth without epidural in a Canadian tertiary center, from the perspectives of doctors, nurses, and patients. METHODS: In this qualitative exploratory study, individual, semi-structured interviews were conducted in 2016 with 5 doctors, 5 nurses, and 4 patients who intended to birth without epidural...
December 18, 2017: Birth
Jaya Jethra Chawla, Devendra Arora, Namrita Sandhu, Megha Jain, Anju Kumari
Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis sometimes with an audible crack at the time of delivery. Unbearable pain on moving from side-to-side and on performing any weight-bearing activity (such as walking or climbing stairs) precludes ambulation in the immediate postpartum period. This could be accompanied by disruption of the sacroiliac joint, hemorrhage, or urine incontinence in severe cases...
November 2017: Oman Medical Journal
Stephanie Whelan, Matthew Kelly
BACKGROUND: Esophageal rupture is an extremely rare condition to occur to a pregnant or postnatal woman. Esophageal ruptures have been previously described in the literature; however, they are most common in the setting of hyperemesis gravidarum. CASE PRESENTATION: This case report describes a 27-year-old white woman who began complaining of central chest pain and shortness of breath 3 hours after a normal vaginal delivery, with no history of vomiting antenatally or intrapartum...
November 6, 2017: Journal of Medical Case Reports
Jennifer G Hensley, Michelle R Collins, Claire L Leezer
Critical care clinicians may be called on to care for a laboring woman. Comprehension of the anatomic changes associated with pregnancy, and labor and birth, is essential. A working knowledge of the current options for pain management in labor, both pharmacologic and nonpharmacologic, is necessary to facilitate patient-centered care. Pharmacologic options include intravenous or intramuscular agents, inhalational agents, and neuraxial anesthesia. Each modality has contraindications, risks, and benefits that must be considered when choosing the most appropriate method...
December 2017: Critical Care Nursing Clinics of North America
Hilal Yuksel, Yasemin Cayir, Zahide Kosan, Kenan Tastan
BACKGROUND: Some research exists on the effect of non-pharmacological approaches for labor pain relief. However, there is limited information about effectiveness of breathing exercises in pregnant women to reduce maternal pain during labor. OBJECTIVE: To determine whether breathing exercises for pregnant women during the second stage of labor have beneficial effects on maternal pain, duration of labor, and the first-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores...
November 2017: Journal of Integrative Medicine
Arthur Yin Fan, David W Miller, Bonnie Bolash, Matthew Bauer, John McDonald, Sarah Faggert, Hongjian He, Yong Ming Li, Amy Matecki, Lindy Camardella, Mel Hopper Koppelman, Jennifer A M Stone, Lindsay Meade, John Pang
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives...
November 2017: Journal of Integrative Medicine
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