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epidural steroids in pregnancy

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https://www.readbyqxmd.com/read/26538126/-vulval-oedema-a-conundrum
#1
REVIEW
Nida Afshan, Leena Gokhale
Massive oedema of the vulva appears to be a sequel of an underlying systemic disease in pregnant women. Isolated vulval oedema in pregnancy is rare. Vulval oedema has been treated, depending on pathophysiology, with steroids, furosemide, albumin and continuous epidural analgaesia. We present a case of vulval oedema, where the oedema was confined to the labia minora in a healthy young pregnant woman. The patient was in pain and extreme discomfort due to the labial swelling, and caesarean section was being considered for delivery as the massive oedema would obstruct the birth canal...
2015: BMJ Case Reports
https://www.readbyqxmd.com/read/23972750/multimodal-postcesarean-delivery-analgesia
#2
REVIEW
Anne Lavoie, Paloma Toledo
Cesarean deliveries can be associated with moderate to severe postoperative pain. Appropriate management of pain is important because it results in better patient satisfaction, earlier mobilization, and improved maternal-infant bonding. There are many individual options for treatment of pain; however, multimodal analgesic therapy has become the mainstay of treatment. In this article, the epidemiology of postcesarean delivery pain, pain mechanisms, and the multiple options available to providers for treatment of postoperative pain are discussed...
September 2013: Clinics in Perinatology
https://www.readbyqxmd.com/read/23921652/the-efficacy-of-2-doses-of-epidural-morphine-for-postcesarean-delivery-analgesia-a-randomized-noninferiority-trial
#3
RANDOMIZED CONTROLLED TRIAL
Sudha I Singh, Sarah Rehou, Kristine L Marmai, Philip M Jones
BACKGROUND: A single dose of epidural morphine is effective in reducing pain after cesarean delivery but is associated with adverse effects. In this study, we sought to establish whether half the traditional dose of epidural morphine, when administered as part of a multimodal analgesia regimen after cesarean delivery, was associated with noninferior analgesia and fewer adverse effects. METHODS: Ninety term parturients undergoing cesarean delivery under epidural anesthesia were enrolled in this randomized, double-blinded, noninferiority study...
September 2013: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/23419417/-enhanced-recovery-after-caesarean-delivery-a-practice-survey-in-two-french-regions
#4
COMPARATIVE STUDY
A Wyniecki, M Raucoules-Aimé, J de Montblanc, D Benhamou
AIMS: Although most components of an enhanced recovery programme (ERP) can be applied to caesarean delivery, it is unknown if their implementation is large in France. TYPE OF STUDY: Structured interview by telephone or e-mailing of an anaesthetist to describe usual perioperative practice in two French regions (Provence - Alpes - Côte d'Azur [PACA] and Île-de-France [IDF]). METHODS: Questionnaire related to scheduled caesarean delivery. RESULTS: Response rate 74% (111/149 maternity units)...
March 2013: Annales Françaises D'anesthèsie et de Rèanimation
https://www.readbyqxmd.com/read/22918029/epidural-lipomatosis-causing-new-debilitating-back-pain-in-a-patient-with-human-immunodeficiency-virus-on-highly-active-antiretroviral-therapy
#5
F Billings, M R Hoyt
Spinal epidural lipomatosis is a rare condition of adipose tissue hypertrophy in the epidural space. Through nerve root and spinal canal compression, it may lead to both sensory and motor compromise. Chronic steroid use, obesity and other metabolic derangements are known causes of spinal epidural lipomatosis. Recently, several cases have been attributed to antiretrovirals taken to treat human immunodeficiency virus, given their side effects of lipodystrophy and altered fat metabolism. We report a patient on highly active antiretroviral therapy (HAART) who developed debilitating back, hip and thigh pain during the third trimester of pregnancy that prevented ambulation...
October 2012: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/22786524/non-opioid-drugs-for-pain-management-in-labour
#6
REVIEW
Mohammad Othman, Leanne Jones, James P Neilson
BACKGROUND: Labour is a normal physiological process, but is usually associated with pain and discomfort. Numerous methods are used to relieve labour pain. These include pharmacological (e.g. epidural, opioids, inhaled analgesia) and non-pharmacological (e.g. hypnosis, acupuncture) methods of pain management. Non-opioid drugs are a pharmacological method used to control mild to moderate pain. OBJECTIVES: To summarise the evidence regarding the effects and safety of the use of non-opioid drugs to relieve pain in labour...
July 11, 2012: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/21914755/effect-of-caudal-epidural-steroid-or-saline-injection-in-chronic-lumbar-radiculopathy-multicentre-blinded-randomised-controlled-trial
#7
RANDOMIZED CONTROLLED TRIAL
Trond Iversen, Tore K Solberg, Bertil Romner, Tom Wilsgaard, Jos Twisk, Audny Anke, Oystein Nygaard, Toralf Hasvold, Tor Ingebrigtsen
OBJECTIVE: To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks). DESIGN: Multicentre, blinded, randomised controlled trial. SETTING: Outpatient multidisciplinary back clinics of five Norwegian hospitals. PARTICIPANTS: Between October 2005 and February 2009, 461 patients assessed for inclusion (presenting with lumbar radiculopathy >12 weeks)...
2011: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/21789702/effect-of-flurbiprofen-metoclopramide-and-droperidol-for-nausea-and-emesis-during-cesarean-section-under-spinal-anesthesia
#8
RANDOMIZED CONTROLLED TRIAL
Masafumi Kimura, Tomonori Okamoto, Hiroshi Tsukagoshi, Jun Sato, Shigeru Saito
PURPOSE: Nausea and emesis frequently arise during cesarean section performed under spinal or epidural anesthesia, particularly after delivery. We have evaluated the treatment effects of flurbiprofen, metoclopramide and droperidol on nausea and emesis during cesarean section in patients under combined spinal and epidural anesthesia. METHODS: The patient cohort comprised 361 patients with American Society of Anesthesiologists (ASA) physical status I or II who elected to undergo cesarean section...
October 2011: Journal of Anesthesia
https://www.readbyqxmd.com/read/21511389/second-and-third-trimester-management-of-medical-termination-of-pregnancy-and-fetal-death-in-utero-after-prior-caesarean-section
#9
Mélanie Cayrac, Jean-Luc Faillie, Anaïg Flandrin, Pierre Boulot
OBJECTIVES: To evaluate the results and risks of a protocol for second- and third-trimester termination of pregnancy after prior caesarean section. STUDY DESIGN: This is a retrospective study, conducted in a level 3 (university hospital) maternity unit between January 2001 and September 2008. 67 women with a history of caesarean section underwent second- and third-trimester termination of pregnancy. The protocol was administration of 600 mg mifepristone the first day and application of laminaria tents the second day...
August 2011: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/21112761/maternal-myasthenia-gravis-complicated-by-fetal-arthrogryposis-multiplex-congenita
#10
J T Chieza, I Fleming, N Parry, V A Skelton
We report the management of a 24-year-old primigravid woman who was diagnosed with myasthenia gravis at 20weeks of gestation. Maternal symptoms improved with therapeutic plasma exchange, steroids, immunoglobulin therapy and pyridostigmine. Despite this, the fetus had arthrogryposis multiplex congenita due to trans-placental transfer of anti-acetylcholine receptor antibodies. The baby was delivered by elective caesarean section at 34weeks of gestation but died in the immediate postpartum period. The mother underwent thymectomy within five weeks of delivery...
January 2011: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/21102964/trial-spinal-cord-stimulator-reimplantation-following-lead-breakage-after-third-birth
#11
Naozumi Takeshima, Kentaro Okuda, Junji Takatanin, Satoshi Hagiwra, Takayuki Noguchi
BACKGROUND: Many studies have reported lead migration and breakage as complications of epidural spinal cord stimulation. In cases where rapid changes in physique such as those caused by pregnancy are expected, it is unclear whether extra consideration regarding possible adjustments and care to avoid complications such as lead breakage are required. OBJECTIVE: This article presents a case in which spinal cord stimulation was used to manage these complications in a woman during the perinatal period...
November 2010: Pain Physician
https://www.readbyqxmd.com/read/19954964/analgesic-requirements-and-postoperative-recovery-after-scheduled-compared-to-unplanned-cesarean-delivery-a-retrospective-chart-review
#12
COMPARATIVE STUDY
B Carvalho, L Coleman, A Saxena, A J Fuller, E T Riley
BACKGROUND: Studies examining the effects of various analgesics and anesthetics on postoperative pain following cesarean delivery conventionally use the scheduled cesarean population. This study compares postoperative analgesic requirements and recovery profiles in women undergoing scheduled cesarean compared to unplanned cesarean delivery following labor. We postulated that unplanned cesarean deliveries may increase postoperative analgesic requirements. METHODS: We conducted a retrospective chart review of 200 cesarean deliveries at Lucile Packard Children's Hospital, California...
January 2010: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/17489475/expanded-health-data-from-the-new-birth-certificate-2004
#13
Joyce A Martin, Fay Menacker
OBJECTIVES: This is the first report to present maternal and infant health information exclusive to the 2003 revision of the U.S. Standard Certificate of Live Birth. Information is shown for the items: Risk factors in this pregnancy, Obstetric procedures, Characteristics of labor and delivery, Method of delivery, Abnormal conditions of the newborn, and Congenital anomalies of the newborn. These items are included on both the 1989 and the 2003 U.S. Standard Certificate of Live Birth; however, many of the specific checkboxes were modified, or are new to the 2003 certificate...
April 19, 2007: National Vital Statistics Reports
https://www.readbyqxmd.com/read/17458644/lornoxicam-and-ondansetron-for-the-prevention-of-intrathecal-fentanyl-induced-pruritus
#14
RANDOMIZED CONTROLLED TRIAL
Nurcin Gulhas, Feray Akgul Erdil, Ozlem Sagir, Ender Gedik, Turkan Togal, Zekine Begec, M Ozcan Ersoy
PURPOSE: In this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section. METHODS: One hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 microg and hyperbaric bupivacaine 12 mg...
2007: Journal of Anesthesia
https://www.readbyqxmd.com/read/16980157/postcesarean-analgesia-the-efficacy-of-bupivacaine-wound-instillation-with-and-without-supplemental-diclofenac
#15
RANDOMIZED CONTROLLED TRIAL
Edna Zohar, Arie Shapiro, Alex Eidinov, Ami Fishman, Brian Fredman
STUDY OBJECTIVE: To assess the analgesic efficacy of diclofenac when administered as an adjuvant to bupivacaine wound instillation. DESIGN: Prospective, randomized, double blind, placebo-controlled study. SETTING: Large referral hospital. PATIENTS: 90 women recovering from cesarean delivery performed via a Pfannenstiel incision. INTERVENTIONS: A standard intrathecal anesthetic was administered...
September 2006: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/16875647/maternal-corticosteroids-to-prevent-intrauterine-exposure-to-hyperthermia-and-inflammation-a-randomized-double-blind-placebo-controlled-trial
#16
RANDOMIZED CONTROLLED TRIAL
Laura Goetzl, Israel Zighelboim, Martina Badell, Jose Rivers, Mary Ann Mastrangèlo, David Tweardy, Maya S Suresh
OBJECTIVE: Intrauterine exposure to hyperthermia at term is associated with adverse neonatal neurologic outcomes. The objective of this study was to determine whether prophylactic maternal corticosteroid treatment prevents fetal exposure to hyperthermia and inflammatory cytokines after epidural analgesia. STUDY DESIGN: A 2-phase, randomized, institutional review board-approved, double-blind, placebo-controlled trial was performed. Term nulliparous women were enrolled at epidural placement...
October 2006: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/16738294/epidural-dextran-40-and-paramethasone-injection-for-treatment-of-spontaneous-intracranial-hypotension
#17
Ivan Bel, Luis-Alfonso Moreno, Carmen Gomar
PURPOSE: This report describes treatment with epidural dextran-40 and paramethasone injection of postural headache resulting from spontaneous intracranial hypotension in a pregnant patient. CLINICAL FEATURES: A 39-yr-old pregnant woman consulted the pain clinic for the assessment of a debilitating postural headache which was non-responsive to conventional analgesic treatment. Clinical findings and cranial magnetic resonance imaging indicated the diagnosis of spontaneous intracranial hypotension syndrome...
June 2006: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/16698864/anaesthetic-management-of-a-parturient-with-the-postural-orthostatic-tachycardia-syndrome-a-case-report
#18
W L Corbett, C M Reiter, J R Schultz, R J Kanter, A S Habib
Postural orthostatic tachycardia syndrome encompasses a group of disorders characterized by orthostatic intolerance. We describe the anaesthetic management of analgesia for labour and of Caesarean section in a parturient suffering from this disorder. Worsening of her symptoms during pregnancy was managed with an increase in the dose of beta-blockers taken by the patient. Epidural analgesia was instigated early to attenuate the stress of labour and avoid consequent triggering of a tachycardic response. Slow titration of epidural analgesia and anaesthesia after an adequate fluid preload was undertaken to minimize hypotension and subsequent tachycardia...
August 2006: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/16585885/-multiple-sclerosis-and-pregnancy
#19
REVIEW
S Vukusic, C Confavreux
The influence of pregnancy in multiple sclerosis (MS) has been a matter of controversy for a long time. Women with MS were often discouraged to envisage pregnancy. The Pregnancy in Multiple Sclerosis (PRIMS) study was the first large-scale prospective study aimed at assessing the possible influence of pregnancy and delivery on the clinical course of MS. Two hundred and fifty-four women with a diagnosis of MS were included during pregnancy and followed-up till the end of the second year post partum. The results were a reduction in the relapse rate during pregnancy, in comparison to the year before pregnancy, especially marked in the third trimester, and a significant increase in the relapse rate in the first trimester post partum...
March 2006: Revue Neurologique
https://www.readbyqxmd.com/read/16430549/ondansetron-and-tropisetron-do-not-prevent-intraspinal-morphine-and-fentanyl-induced-pruritus-in-elective-cesarean-delivery
#20
RANDOMIZED CONTROLLED TRIAL
P J Sarvela, P M Halonen, A I Soikkeli, J P Kainu, K T Korttila
BACKGROUND: Although intraspinal morphine has been shown to be effective in providing analgesia after cesarean delivery, pruritus as a side-effect remains a common cause of dissatisfaction. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory. METHODS: We randomized 98 parturients undergoing elective cesarean section using combined spinal-epidural anesthesia into a double-blinded trial to receive tropisetron 5 mg (T group) or ondansetron 8 mg (O group) or placebo (NaCl group) after delivery, when intrathecal morphine 160 microg and fentanyl 15 microg were used for post-operative pain control...
February 2006: Acta Anaesthesiologica Scandinavica
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