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Labor analgesia

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https://www.readbyqxmd.com/read/29049070/noninfectious-fever-in-the-near-term-pregnant-rat-induces-fetal-brain-inflammation-a-model-for-the-consequences-of-epidural-associated-maternal-fever
#1
Scott Segal, Carlo Pancaro, Iwona Bonney, James E Marchand
BACKGROUND: Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the near-term pregnant rat to simulate the pathophysiology of epidural-associated fever and hypothesized that it would produce fetal brain inflammation. METHODS: Twenty-four pregnant Sprague-Dawley rats were studied at 20 days gestation (term: 22 days)...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29033728/anesthesia-in-pregnancy-with-heart-disease
#2
REVIEW
Ankur Luthra, Ritika Bajaj, Anudeep Jafra, Kiran Jangra, V K Arya
Management of pregnant women with heart disease remains challenging due to the advancement of innovations in cardiac surgery and correction of complex cardiac anomalies, and more recently, with the successful performance of heart transplants, cardiac diseases are not only likely to coexist with pregnancy, but will also increase in frequency over the years to come. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29016499/epidural-analgesia-during-the-second-stage-of-labor-a-randomized-controlled-trial
#3
XiaoFeng Shen, Yunping Li, ShiQin Xu, Nan Wang, Sheng Fan, Xiang Qin, Chunxiu Zhou, Philip E Hess
OBJECTIVE: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.08% ropivacaine with 0...
October 6, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28991063/dose-response-curves-for-intrathecal-bupivacaine-levobupivacaine-and-ropivacaine-given-for-labor-analgesia-in-nulliparous-women
#4
Warwick D Ngan Kee, Floria F Ng, Kim S Khaw, Shannon P Y Tang, Alison G P Koo
BACKGROUND AND OBJECTIVES: Bupivacaine, levobupivacaine, and ropivacaine are often given intrathecally for labor analgesia, but limited data are available for their dose-response properties in this context. The objective of this study was to describe the dose-response curves of these local anesthetics when given intrathecally for labor analgesia, to determine values for D50 (dose producing a 50% response) and to compare the calculated values of D50 for levobupivacaine and ropivacaine with those for bupivacaine...
November 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28941065/an-economic-model-of-professional-doula-support-in-labor-in-british-columbia-canada
#5
Gillian E Hanley, Lily Lee
INTRODUCTION: Spending on care in childbirth represents a sizable portion of health care budgets. This has engendered a growing interest in potential clinical tools that could be used to improve patient experience and population health at a lower cost. A possible such tool is continuous support in labor from a trained doula, as doula care can decrease the likelihood of cesarean birth, epidural analgesia, and assisted vaginal birth. In addition, there is some emerging evidence suggesting that involving doulas in prenatal care can reduce rates of preterm birth...
September 20, 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28938298/safety-and-efficacy-of-epidural-analgesia
#6
Elke M E Bos, Markus W Hollmann, Philipp Lirk
PURPOSE OF REVIEW: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. RECENT FINDINGS: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28936908/central-neuraxial-analgesia-for-labor-an-update-of-the-literature
#7
Serena Sodha, Alexandra Reeve, Roshan Fernando
Numerous techniques are in use to provide analgesia for labor, of which central neuraxial block is widely considered superior to non-neuraxial options. Central neuraxial techniques have evolved over many years to provide greater efficacy, safety and maternal satisfaction. This narrative review focuses on the literature relating to central neuraxial labor analgesia from the past 5 years, from November 2010 to October 2015. We discuss the evidence related to the various central neuraxial techniques used, the increasingly widespread use of ultrasound guidance and the evidence surrounding other novel methods of central neuraxial block insertion...
September 2017: Pain Management
https://www.readbyqxmd.com/read/28930940/the-relationship-between-women-s-intention-to-request-a-labor-epidural-analgesia-actually-delivering-with-labor-epidural-analgesia-and-postpartum-depression-at-6-weeks-a-prospective-observational-study
#8
Sharon Orbach-Zinger, Ruth Landau, Avi Ben Harousch, Oren Ovad, Liron Caspi, Evgeniya Kornilov, Alexander Ioscovich, Danielle Bracco, Atara Davis, Shlomo Fireman, Moshe Hoshen, Leonid A Eidelman
BACKGROUND: Postpartum depression (PPD) is associated with pain during and after delivery, with studies showing reduced rates among women delivering with labor epidural analgesia (LEA). We hypothesized that women who intend to deliver with LEA but do not receive it are at higher risk for PPD at 6 weeks due to the combined experience of untreated labor pain and unmatched expectations during labor, and evaluated the interaction between labor plans related to LEA, satisfaction with pain control when actually delivering with LEA, and PPD at 6 weeks after delivery...
September 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28928565/clonidine-as-an-adjuvant-to-lignocaine-infiltration-for-prolongation-of-analgesia-after-episiotomy
#9
Upasna Bhatia, Premal Soni, Udit Khilji, Yamini N Trivedi
BACKGROUND: Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, "episiotomy infiltration" becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1(st) day of postpartum period. OBJECTIVES: We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928552/comparative-efficacy-of-minimal-concentration-of-racemic-bupivacaine-0-0625-with-fentanyl-and-ropivacaine-0-1-with-fentanyl-for-epidural-labor-analgesia
#10
T N Chethanananda, M R Shashank, N Madhu, J Achyutha, Karna Venkata Siva Kumar
BACKGROUND AND AIMS: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. SETTINGS AND DESIGN: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28926440/epidural-labor-analgesia-fentanyl-dose-and-breastfeeding-success-a-randomized-clinical-trial
#11
RANDOMIZED CONTROLLED TRIAL
Amy I Lee, Robert J McCarthy, Paloma Toledo, Mary Jane Jones, Nancy White, Cynthia A Wong
BACKGROUND: Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. METHODS: The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia...
October 2017: Anesthesiology
https://www.readbyqxmd.com/read/28926438/labor-epidural-analgesia-and-breastfeeding
#12
David H Chestnut
No abstract text is available yet for this article.
October 2017: Anesthesiology
https://www.readbyqxmd.com/read/28921607/in-labor-or-in-limbo-the-experiences-of-women-undergoing-induction-of-labor-in-hospital-findings-of-a-qualitative-study
#13
Annabel Jay, Hilary Thomas, Fiona Brooks
BACKGROUND: Induction of labor currently accounts for around 25% of all births in high-resource countries, yet despite much research into medical aspects, little is known about how women experience this process. This study aimed to explore in depth the induction experience of primiparous women. METHODS: A qualitative study was undertaken, using a sample of 21 first-time mothers from a maternity unit in the south of England. Semi-structured interviews were conducted in women's homes between 3 and 6 weeks postnatally...
September 17, 2017: Birth
https://www.readbyqxmd.com/read/28915426/intravenous-dexamethasone-as-an-adjunct-to-improve-labor-analgesia-a-randomized-double-blinded-placebo-controlled-clinical-trial
#14
Pratibha Dube, Sukanya Mitra, Jasveer Singh, Richa Saroa, Reeti Mehra
OBJECTIVE: To study the role of intravenous (i.v.) dexamethasone as an analgesic adjunct in labor analgesia. DESIGN: Double-blinded randomized controlled trial. SETTING: Labor analgesia in a tertiary-care teaching hospital. PATIENTS: Eighty consenting ASA I-II parturients, age>18year, nulliparous, single gestation, cephalic presentation at ≥36 wk. of gestation, in early spontaneous labor (cervical dilatation≤5cm) requesting epidural analgesia...
September 12, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28898687/outcomes-of-mifepristone-usage-for-cervical-ripening-and-induction-of-labour-in-full-term-pregnancy-randomized-controlled-trial
#15
Oleg R Baev, Valentina P Rumyantseva, Oleg V Tysyachnyu, Olga A Kozlova, Gennady T Sukhikh
OBJECTIVE: The most commonly used approved indications for mifepristone in obstetrics include: termination of early pregnancy, cervical dilatation prior to abortion, labour induction in case of fetal death in utero. Fewer studies have been conducted on the effect of mifepristone on cervical ripening and induction of labour in term pregnancy with a live fetus. The aim of our study was to evaluate efficacy and safety of mifepristone use for cervical ripening and induction of labour versus expectant management in full-term pregnancy...
October 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28884414/effect-of-programmed-intermittent-epidural-boluses-and-continuous-epidural-infusion-on-labor-analgesia-and-obstetric-outcomes-a-randomized-controlled-trial
#16
Leopoldo E Ferrer, David J Romero, Oscar I Vásquez, Ednna C Matute, Marc Van de Velde
PURPOSE: Continuous epidural infusion and programmed intermittent epidural boluses are analgesic techniques routinely used for pain relief in laboring women. We aimed to assess both techniques and compare them with respect to labor analgesia and obstetric outcomes. METHODS: After Institutional Review Board approval, 132 laboring women aged between 18 and 45 years were randomized to epidural analgesia of 10 mL of a mixture of 0.1% bupivacaine plus 2 µg/mL of fentanyl either by programmed intermittent boluses or continuous infusion (66 per group)...
September 7, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28875709/continuous-epidural-infusion-versus-programmed-intermittent-epidural-bolus-for-labor-analgesia-optimal-configuration-of-parameters-to-reduce-physician-administered-top-ups
#17
Carlos Delgado, Christopher Ciliberto, Laurent Bollag, Margaret Sedensky, Ruth Landau
BACKGROUND AND OBJECTIVES: Programmed intermittent epidural bolus (PIEB) is a delivery mode associated with decreased local analgesia dosing, motor block, and physician-administered top-ups (PATU) during labor analgesia. We hypothesized that PIEB delivery at different settings will result in fewer PATU for labor analgesia than the same hourly volume of a continuous epidural infusion (CEI). METHODS: 'Before and after' study design of combined-spinal epidural (CSE) for labor, with bupivacaine 0...
September 6, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28861414/continuous-spinal-anesthesia-for-obstetric-anesthesia-and-analgesia
#18
REVIEW
Ivan Veličković, Borislava Pujic, Charles W Baysinger, Curtis L Baysinger
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28858898/the-accuracy-of-a-handheld-ultrasound-device-for-neuraxial-depth-and-landmark-assessment-a-prospective-cohort-trial
#19
Katherine M Seligman, Carolyn F Weiniger, Brendan Carvalho
This study investigated the accuracy of a wireless handheld ultrasound with pattern recognition software that recognizes lumbar spine bony landmarks and measures depth to epidural space (Accuro, Rivanna Medical, Charlottesville, VA) (AU). AU measurements to epidural space were compared to Tuohy needle depth to epidural space (depth to loss of resistance at epidural placement). Data from 47 women requesting labor epidural analgesia were analyzed. The mean difference between depth to epidural space measured by AU versus needle depth was -0...
August 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28841452/epidural-labor-analgesia-whence-come-our-patients-misconceptions
#20
EDITORIAL
Unyimi Ituk, Cynthia A Wong
No abstract text is available yet for this article.
November 2017: Journal of Clinical Anesthesia
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