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https://www.readbyqxmd.com/read/28221178/non-neuraxial-labor-analgesia-options
#1
John C Markley, Mark D Rollins
Although it is the most effective method to treat labor pain, neuraxial analgesia may be undesired, contraindicated, unsuccessful, or unavailable. Providing safe choices for labor pain relief is a central goal of health care providers alike. Consequently, knowledge of the efficacy, clinical implementation, and side effects of various non-neuraxial strategies is needed to provide appropriate options for laboring patients. In addition to nonpharmacologic alternatives, inhaled nitrous oxide and systemic opioids represent two broad classes of non-neuraxial pharmacologic labor analgesia most commonly available...
February 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28217056/preprocedural-ultrasound-examination-versus-manual-palpation-for-thoracic-epidural-catheter-insertion
#2
Ahmed M Hasanin, Ali M Mokhtar, Shereen M Amin, Ahmed A Sayed
BACKGROUND AND AIMS: Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations. SUBJECTS AND METHODS: Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28185794/neuraxial-opioids-for-post-cesarean-delivery-analgesia-can-hydromorphone-replace-morphine-a-retrospective-study
#3
B Marroquin, C Feng, A Balofsky, K Edwards, A Iqbal, J Kanel, M Jackson, M Newton, D Rothstein, E Wong, R Wissler
BACKGROUND: Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia. METHODS: A retrospective chart review was performed of women who underwent cesarean delivery and received neuraxial anesthesia from March to November 2011 and from March to November 2012. A total of 450 patients received intrathecal morphine 200μg and 387 patients received intrathecal hydromorphone 60μg...
December 30, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28183557/parturient-recall-of-neuraxial-analgesia-risks-impact-of-labor-pain-vs-no-labor-pain
#4
Christopher M Burkle, David A Olsen, Hans P Sviggum, Adam K Jacob
STUDY OBJECTIVE: Information exchange between anesthesia providers and parturients about neuraxial analgesia risks often occurs in the presence of labor pain. This study examined whether the presence of pain impacted the level of recall of information provided to parturients regarding risks of neuraxial techniques. DESIGN: Single-center, nonrandomized study. SETTING: Labor and delivery suite and postpartum patient rooms in a large academic medical center...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28131114/optimal-pain-management-after-cesarean-delivery
#5
REVIEW
Caitlin Dooley Sutton, Brendan Carvalho
Cesarean delivery rates are increasing worldwide, and effective postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28118226/intraoperative-placement-of-pectoral-nerve-block-catheters-description-of-a-novel-technique-and-review-of-the-literature
#6
Katharine M Hinchcliff, Jared R Hylton, Hakan Orbay, Michael S Wong
Regional and neuraxial anesthesia for pain management after breast surgery is not widely used despite data showing improved postoperative pain control and patient satisfaction scores. We report a case of a 61-year-old woman who underwent bilateral mastectomies, and received postoperative analgesia via pectoral nerves 1 and 2 nerve blocks. This case highlights a previously undescribed technique of prolonged postoperative pain control by intraoperative placement of pectoral nerves 1 and 2 regional anesthesia catheters under direct visualization...
January 23, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28102539/determination-of-the-median-effective-dose-ed50-of-spinal-chloroprocaine-in-labour-analgesia
#7
M Coppens, S Anssens, A Parashchanka, K Roelens, E Deschepper, S De Hert, P F Wouters
The primary goal of this study was to determine the median effective dose (ED50 ) of spinal chloroprocaine for labour analgesia. Thirty-eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up-down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal-epidural, which was then supplemented with an epidural dose of 7.5 μg sufentanil in 7 ml saline...
January 19, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28099291/transcutaneous-carbon-dioxide-measurements-in-women-receiving-intrathecal-morphine-for-cesarean-delivery-a-prospective-observational-study
#8
Jeanette R Bauchat, Robert McCarthy, Paul Fitzgerald, Stephen Kolb, Cynthia A Wong
BACKGROUND: Neuraxial morphine is the most commonly used analgesic technique after cesarean delivery. The incidence of respiratory depression is reported to be very low (0%-1.2%) in this patient population as measured by pulse oximetry and respiratory rates. However, hypercapnia may be a more sensitive measure of respiratory depression. In the current study, the incidence of hypercapnia events (transcutaneous CO2 [TcCO2] >50 mm Hg) for ≥2-minute duration was evaluated using the Topological Oscillation Search with Kinematical Analysis monitor in women who received intrathecal morphine for postcesarean delivery analgesia...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28079734/thoracic-epidural-anesthesia-and-prophylactic-three-times-daily-unfractionated-heparin-within-an-enhanced-recovery-after-surgery-pathway-for-colorectal-surgery
#9
Alexander B Stone, Michael C Grant, Brandyn D Lau, Deborah B Hobson, Michael B Streiff, Elliot R Haut, Christopher L Wu, Elizabeth C Wick
BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) is a common cause of preventable harm. Perioperative thoracic epidural analgesia (TEA) presents a challenge to optimal VTE prophylaxis. Our primary aim was to characterize missed doses of VTE prophylaxis associated with epidural catheter placement and removal. Our secondary aim was to measure the effect of an enhanced recovery after surgery (ERAS) pathway on the rate of TEA-associated missed VTE prophylaxis. METHODS: We retrospectively reviewed a prospectively collected database of 1264 colorectal surgery patients at a single academic center...
March 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28079666/intravenous-tissue-plasminogen-activator-administration-for-ischemic-stroke-1-hour-after-epidural-catheter-removal-a-case-report
#10
Anne M Baciewicz, Calvin Lee, Alon Ben-Ari, Hojoong Kim, Alex T Lee
Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia...
January 11, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28079662/recognition-of-a-thoracic-epidural-hematoma-in-the-setting-of-transient-paralysis-a-case-report
#11
Beth VanderWielen, Lindsay Rubenstein, Marc Shnider, Cindy Ku, Jason Wakakuwa
A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use...
January 11, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28074295/-neuraxial-anaesthesia-and-noacs
#12
T Standl
BACKGROUND: Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia. OBJECTIVE: The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28067707/dural-puncture-epidural-technique-improves-labor-analgesia-quality-with-fewer-side-effects-compared-with-epidural-and-combined-spinal-epidural-techniques-a-randomized-clinical-trial
#13
Anthony Chau, Carolina Bibbo, Chuan-Chin Huang, Kelly G Elterman, Eric C Cappiello, Julian N Robinson, Lawrence C Tsen
BACKGROUND: The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28034599/neuraxial-analgesia-in-a-pregnant-woman-with-fowler-s-syndrome-and-sacral-neuromodulation
#14
M Ansó, L Veiga-Gil, J De Carlos, A Hualde, J Pérez-Cajaraville
We report the anesthetic management of a 16-year-old woman with Fowler's syndrome who became pregnant three years after sacral neuromodulation was initiated for treatment of the condition. Multidisciplinary consensus was to switch off the neurostimulator during pregnancy, and attempt vaginal delivery with a neuraxial block. When the patient was admitted for labor, an epidural catheter was placed successfully. The patient had a normal vaginal delivery. Sacral neuromodulation was restarted uneventfully in the early puerperium and the Fowler's syndrome remains well controlled...
December 5, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28002168/nitrous-oxide-during-labor-maternal-satisfaction-does-not-depend-exclusively-on-analgesic-effectiveness
#15
Michael G Richardson, Brandon M Lopez, Curtis L Baysinger, Matthew S Shotwell, David H Chestnut
BACKGROUND: Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction. We sought to compare the relationship between analgesic effectiveness and patient satisfaction with analgesia in women who delivered vaginally using nitrous oxide, neuraxial analgesia (epidural or combined spinal-epidural [CSE]), or both (neuraxial after a trial of nitrous oxide)...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27984250/a-randomized-controlled-trial-of-music-use-during-epidural-catheter-placement-on-laboring-parturient-anxiety-pain-and-satisfaction
#16
Dan M Drzymalski, Lawrence C Tsen, Arvind Palanisamy, Jie Zhou, Chuan-Chin Huang, Bhavani S Kodali
BACKGROUND: Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis that music use would result in lower anxiety, lower pain, and greater patient satisfaction. METHODS: We conducted a prospective, randomized, controlled trial of laboring parturients undergoing epidural catheter placement with or without music...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27871590/does-nitrous-oxide-labor-analgesia-influence-the-pattern-of-neuraxial-analgesia-usage-an-impact-study-at-an-academic-medical-center
#17
Lesley E Bobb, Michaela K Farber, Catherine McGovern, William Camann
STUDY OBJECTIVE: To compare the rate of epidural use before and after the implementation of nitrous oxide (N2O). DESIGN: Data were obtained from a nursing database of N2O usage and our obstetric anesthesia database. We compared 8 months before and 8 months after the introduction of N2O. It was available 24 h/d, 7 d/wk, consistent with neuraxial analgesia availability. Epidural utilization before and after introduction of N2O was compared using χ(2) analysis. SETTING: Labor and delivery floor...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#18
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27836523/-why-and-how-to-perform-an-ultrasound-guided-transversus-abdominis-plane-block-a-step-by-step-approach
#19
E Nohuz, B El Drayi, A Triki, K Grossmannova, B Boudier, K Koffi, M Albaut, C Dualé
Used in clinical practice as part of a multimodal analgesic regimen, the transversus abdominis plane block (TAP block) is a relative novel procedure in which local anaesthetic agents are injected into the anatomic neurofascial space between the internal oblique and the transversus abdominis muscle. It allows a significantly prolonged duration of analgesia during the early postoperative stage in abdominal surgery. This regional anesthesia technique provides analgesia to the skin, muscles of the anterior abdominal wall and parietal peritoneum in order to decrease the incision-related pain...
December 2016: Gynécologie, Obstétrique & Fertilité
https://www.readbyqxmd.com/read/27833495/postoperative-pain-management-of-liver-transplantation-in-cystic-fibrosis-is-it-time-to-start-us-guided-neuraxial-blocks
#20
M Piazza, G Martucci, A Arcadipane
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy...
October 2016: Saudi Journal of Anaesthesia
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