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Analgesia labor

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https://www.readbyqxmd.com/read/29351097/effect-of-epidural-infusion-bolus-delivery-rate-on-the-duration-of-labor-analgesia-a-randomized-clinical-trial
#1
Elizabeth M S Lange, Cynthia A Wong, Paul C Fitzgerald, Wilmer F Davila, Suman Rao, Robert J McCarthy, Paloma Toledo
BACKGROUND: Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. METHODS: Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial...
January 19, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29346247/concurrent-versus-sequential-intrapleural-instillation-of-tissue-plasminogen-activator-and-deoxyribonuclease-for-pleural-infection
#2
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
https://www.readbyqxmd.com/read/29319586/the-role-of-the-anesthesiologist-in-preventing-severe-maternal-morbidity-and-mortality
#3
Emily McQuaid, Lisa R Leffert, Brian T Bateman
Anesthesiologists are responsible for the safe and effective provision of analgesia for labor and anesthesia for cesarean delivery and other obstetric procedures. In addition, obstetric anesthesiologists often have a unique role as the intensivists of the obstetric suite. The anesthesiologist is frequently the clinician with the greatest experience in the acute bedside management of a hemodynamically unstable patient and expertise in life-saving interventions. This review will discuss (1) risks associated with neuraxial and general anesthesia for labor and delivery, and (2) clinical scenarios in which the obstetric anesthesiologist is commonly called upon to function as a "peridelivery intensivist...
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29310416/medium-term-outcome-of-closed-radial-wedge-osteotomy-of-the-distal-radius-for-preiser-disease-with-concomitant-kienb%C3%A3-ck-disease-two-case-reports-and-a-literature-review
#4
Yuji Tomori, Takuya Sawaizumi, Nanno Mitsuhiko, Shinro Takai
RATIONALE: Idiopathic avascular necrosis of the scaphoid or lunate bone are known as Preiser disease and Kienböck disease, respectively. Although there are reports of avascular necrosis involving more than one carpal bone, concurrent idiopathic avascular necrosis of the scaphoid and lunate bones is rare, with only five cases reported in the English literature (including the two herein). Although the optimum treatment for Preiser disease with concomitant Kienböck disease has not been established, our cases underwent closed radial wedge osteotomy based on the evidence of satisfactory outcomes for treating Kienböck disease...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29278565/nitrous-oxide-for-labor-analgesia
#5
Audrey Hellams, Taylor Sprague, Christina Saldanha, Mark Archambault
Inhaled nitrous oxide (N2O) has been used worldwide for over 100 years as labor analgesia but has not gained widespread use in the United States. Nitrous oxide provides a noninvasive option for laboring women. This article outlines its efficacy and safety as an analgesic compared with epidural and IV pain medications.
January 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/29276414/perceptions-and-practice-of-epidural-analgesia-among-women-attending-antenatal-clinic-in-fetha
#6
Paul O Ezeonu, Okechukwu Bonaventure Anozie, Fidelis A Onu, Chidi U Esike, Johnbosco E Mamah, Lucky O Lawani, Robinson C Onoh, Emmanuel Okechukwu Ndukwe, Richard Lawrence Ewah, Rita Onyinyechi Anozie
Background: The pain of childbirth is arguably the most severe pain that most women will endure in their lifetime. Epidural analgesia is widely used as an effective method of pain relief in labor. It provides almost complete relief of pain if administered timely, and does not affect the progress of the first stage labor. Objectives: The objective of this study was to determine the awareness and utilization of epidural analgesia in labor in pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki (FETHA)...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/29274080/observational-study-using-ultrasound-to-assess-midline-labor-epidural-analgesia-placement-and-analgesic-efficacy
#7
Carolyn F Weiniger, Benjamin Cobb, Rachel R Wang, Brendan Carvalho
OBJECTIVES: Labor epidural analgesia failure may relate to nonmidline placement of epidural catheters. We hypothesized that greater deviations of the epidural catheter insertion point from the ultrasound (US)-determined midline would be associated with less effective labor analgesia. METHODS: A prospective ethically approved cohort study was conducted. Fifty-two healthy average-sized women receiving labor epidural analgesia, inserted by the landmark technique, were approached after delivery...
December 23, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29251370/barriers-and-facilitators-to-birth-without-epidural-in-a-tertiary-obstetric-referral-center-perspectives-of-health-care-professionals-and-patients
#8
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
https://www.readbyqxmd.com/read/29239949/labor-analgesia-as-a-predictor-for-reduced-postpartum-depression-scores-a-retrospective-observational-study
#9
Grace Lim, Lia M Farrell, Francesca L Facco, Michael S Gold, Ajay D Wasan
BACKGROUND: Using labor, epidural analgesia has been linked to a reduced risk of postpartum depression, but the role of labor pain relief in this association remains unclear. The goal of this study was to test the hypothesis that effective epidural analgesia during labor is associated with reduced postpartum depression symptomatology. METHODS: A single, institutional, retrospective, observational cohort design was chosen. The primary outcome was Edinburgh postnatal depression scale (EPDS) score, measured at the 6-week postpartum visit...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29219940/factors-influencing-postpartum-fatigue-in-vaginal-birth-women-testing-a-path-model
#10
Ching-Hsing Hsieh, Chien-Lan Chen, Tan-Ju Han, Pei-Ju Lin, Hui-Chun Chiu
BACKGROUND: Postpartum fatigue is a very common complaint among postpartum women. Although current evidence indicates that several factors (e.g., parity, epidural analgesia, perineal trauma, perineal pain, and longer second stage of labor) are associated with postpartum, not enough is known about the relationships among these physical factors simultaneously and how they contribute to the development of postpartum fatigue. Increased awareness of the complex relationships among these factors will help nurses assess, prevent, and alleviate postpartum fatigue...
December 6, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/29189495/lumbar-spine-anatomy-in-women-sustaining-unintentional-dural-puncture-during-labor-epidural-placement-a-descriptive-study-using-magnetic-resonance-imaging-and-ultrasound
#11
Nicholas M Barrett, Cristian Arzola, Timo Krings, Kristi Downey, Jose C A Carvalho
BACKGROUND AND OBJECTIVES: Unintentional dural puncture is one of the most frequent complications of the epidural technique. One previous study suggested that atypical sonoanatomy of the ligamentum flavum/dura mater unit may be a risk factor for this complication. In this study, we describe the anatomy of the lumbar spine, assessed by magnetic resonance imaging (MRI) and ultrasound, in women sustaining unintentional dural puncture during epidural catheter placement for labor analgesia...
November 15, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29189266/epidural-space-identification-with-loss-of-resistance-technique-for-epidural-analgesia-during-labor-a-randomized-controlled-study-using-air-or-saline-new-arguments-for-an-old-controversy
#12
Nicolas Brogly, Emilia Guasch, Estibaliz Alsina, Carla García, Laura Puertas, Ana Dominguez, Jesús Diez, Jorge Gómez, Fernando Gilsanz
BACKGROUND: The best technique to identify the epidural space for labor analgesia is still unclear despite the publication of various randomized controlled studies and meta-analyses. Our aim was to assess the superiority of the saline loss of resistance (SLOR) technique over the air loss of resistance (ALOR) technique with respect to the quality of the block. METHODS: Consenting parturients admitted to our obstetric suite for spontaneous or induced labor were randomized to receive epidural analgesia using either the ALOR or SLOR technique...
November 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29184440/administration-of-epidural-labor-analgesia-is-not-associated-with-a-decreased-risk-of-postpartum-depression-in-an-urban-canadian-population-of-mothers-a-secondary-analysis-of-prospective-cohort-data
#13
Marissa Nahirney, Amy Metcalfe, Katie H Chaput
Background: Postpartum depression (PPD) is a common complication of pregnancy, affecting approximately 13% of mothers internationally. Previous research has examined whether epidural analgesia used for pain control during labor and birth is associated with a lower risk of PPD, but reports conflicting results and may have suffered from methodological shortcomings. Our study aimed to prospectively assess whether epidural analgesia is associated with a lower risk of PPD (at either 6 weeks or 6 months postpartum) after attempting to adequately adjust for selection bias and confounding variables...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29147776/-pain-therapy-in-obstetrics
#14
J Wallenborn, I Kühnert, D O Chebac, P Kranke
Labor pains can be stronger than pain caused by fractures and as a result of fear and stress can even have a negative effect on the course of parturition. A proportion of 75% of all women in labor use one or more supportive forms of analgesia to relieve labor pains. The procedures used range from supportive non-pharmacological measures, single intramuscular or intravenous analgesics and a prolonged inhalative analgesia up to highly efficient neuraxial blocks. Non-pharmacological interventions are considered to be generally safe but poorly effective...
November 17, 2017: Der Schmerz
https://www.readbyqxmd.com/read/29141373/-a-concentration-response-observation-of-hydromorphone-combined-with-ropivacaine-in-labor-analgesia
#15
Y Y Lu, H Huang, W L Mao, R H Liu, M J Hu, L X Shao, M P Hu, J Li
Objective: To investigate the median effective dose (ED(50)) of hydromorphone and the appropriate concentration of ropivacaine combined with hydromorphone in epidural labor analgesia. Methods: One hundred and forty nulliparous women undergoing labor selected for delivery with epidural analgesia were enrolled in our hospital from January to June 2016. The first of top 50 women received 0.12% ropivacaine plus 20 μg/ml hydromorphone complex solution, then sequential women were used the modified sequential method to determine the ED(50) and ED(95) of hydromorphone...
November 14, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29123430/the-use-of-invos%C3%A2-somatic-oximetry-to-measure-variations-in-placental-tissue-oxygenation-in-laboring-healthy-term-parturients-with-epidural-analgesia-an-observational-study
#16
Christian Loubert, Mélissa Ouellette, Valérie Zaphiratos, Issam Tanoubi
Purpose: Near-infrared spectroscopy provides a non-invasive continuous real-time monitoring of tissue oxygen saturation. As uterine contractions during labor may be associated with a transient uteroplacental hypoperfusion, this prospective, observational study investigates the ability of near-infrared spectroscopy to detect variation in uteroplacental oximetry during uterine contractions. Patients and methods: Four Invos™ oximetry probes (Medtronic(®), Minneapolis, MN, USA) per subjects were applied on the placental surface (PLA), the abdomen (MYO), the forearm (ARM) and the leg (LEG), of twenty healthy laboring parturients with epidural analgesia...
2017: Medical Devices: Evidence and Research
https://www.readbyqxmd.com/read/29112650/maternal-pulse-pressure-and-the-risk-of-postepidural-complications-a-randomized-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
Justin R Lappen, Stephen A Myers, Norman Bolen, Brian M Mercer, Edward K S Chien
OBJECTIVE: To test the hypothesis that increasing the intravenous fluid bolus volume at the time of epidural placement in women with narrow pulse pressure would reduce postepidural fetal heart rate (FHR) abnormalities, hypotension, and resuscitative obstetric interventions. METHODS: We performed a single-center randomized controlled trial. Eligible participants were normotensive with a nonanomalous singleton gestation at or after 35 weeks and with a narrow pulse pressure (less than 45 mm Hg) on admission...
December 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29108725/aplastic-anemia-in-two-consecutive-pregnancies-obstetric-and-anesthetic-management
#18
E Riveros-Perez, A Hermesch, L Barbour, J Hawkins
Aplastic anemia is a serious condition occasionally coexisting with pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management are particularly challenging, and treatment requires knowledge of pathophysiologic mechanisms in order to provide safe care to this group of patients. We describe the successful obstetric management and labor analgesia of a patient with a diagnosis of aplastic anemia in two consecutive pregnancies...
September 14, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29099021/a-prospective-randomized-trial-of-postural-changes-vs-passive-supine-lying-during-the-second-stage-of-labor-under-epidural-analgesia
#19
María Simarro, José Angel Espinosa, Cecilia Salinas, Ricardo Ojea, Paloma Salvadores, Carolina Walker, José Schneider
There exist very few studies comparing different postures or postural changes during labor in parturients with epidural analgesia. AIM: To disclose whether the intervention of a multidisciplinary nursing team including a physiotherapist during the second stage of labor improves the obstetric outcome in parturients with epidural analgesia. DESIGN: Prospective randomized trial. SETTING: University-affiliated hospital. POPULATION: Women undergoing labor with epidural analgesia after a normal gestation...
March 8, 2017: Medical Sciences: Open Access Journal
https://www.readbyqxmd.com/read/29096283/positions-during-the-first-stage-and-the-passive-second-stage-of-labor-a-survey-of-french-midwives
#20
Chloé Barasinski, Anne Debost-Legrand, Didier Lémery, Françoise Vendittelli
OBJECTIVE: the objective of our study was to describe the practices reported by French midwives during labor (first stage and passive phase of the second stage). DESIGN: this cross-sectional internet questionnaire surveyed French midwives who attended at least one delivery in 2013. SETTING: this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS: 1496 midwives from 377 maternity units participated in the study...
October 17, 2017: Midwifery
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