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Labour Analgesia

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253 papers 500 to 1000 followers A collection from an obstetric anesthesiologist with an interest in patient centred analgesia and new modalities
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
Danielle M Gleeson, Alison Craswell, Christian M Jones
BACKGROUND: Social support is essential in both the transition to motherhood and maternal role development. With diminishing access to traditional communities of motherhood wisdom, women struggle to access this information in their tangible worlds. AIM: This paper presents a review of the research literature investigating childbearing women's use of social networking sites related to pregnancy and parenting and how these may influence women's experiences of the childbearing period...
December 31, 2018: Women and Birth: Journal of the Australian College of Midwives
C Luke Dixon, Luis Monsivais, Petra Chamseddine, Gayle Olson, Luis D Pacheco, George R Saade, Maged M Costantine
OBJECTIVE:  To assess whether distraction using music and/or video games influences timing of analgesia request and improves pain outcomes in women undergoing labor induction. STUDY DESIGN:  A total of 219 pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to distraction with music and video games via iPod ( n  = 109) or no iPod ( n  = 110). The primary outcome was the time from FB placement to request for pain medication...
January 4, 2019: American Journal of Perinatology
S Ciechanowicz, T Setty, E Robson, C Sathasivam, M Chazapis, J Dick, B Carvalho, P Sultan
BACKGROUND: Whilst validated quality-of-recovery (QoR) tools exist for general surgery, there is no specific obstetric equivalent. We aimed to develop and evaluate a modified QoR score after elective Caesarean delivery. METHODS: Twenty-two obstetric specific items were selected following review and modification of the QoR-40 survey by 16 experts and interviews with 50 stakeholders. Item selection was based on relevance to Caesarean delivery and endorsement by >66% of stakeholders...
January 2019: British Journal of Anaesthesia
T Malik, O Malas, A Thompson
BACKGROUND: Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. METHODS: One-hundred parturients requesting epidural analgesia were randomly assigned to receive ultrasound-guided L5-S1 epidural catheter placement (experimental group) or non-ultrasound-guided higher lumbar interspace placement (control group)...
November 20, 2018: International Journal of Obstetric Anesthesia
A A Melber
No abstract text is available yet for this article.
December 14, 2018: Anaesthesia
Sana Amjad, Isaiah MacDonald, Thane Chambers, Alvaro Osornio-Vargas, Sujata Chandra, Don Voaklander, Maria B Ospina
BACKGROUND: Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers. METHODS: Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes...
December 5, 2018: Paediatric and Perinatal Epidemiology
J B Bavaro, J L Mendoza, R J McCarthy, P Toledo, J R Bauchat
BACKGROUND: Early maternal skin-to-skin contact confers numerous benefits to the newborn, but maternal sedation during cesarean delivery could have safety implications for early skin-to-skin contact in the operating room. We compared patient-reported and observer-assessed levels of sedation during unscheduled and scheduled cesarean deliveries. METHODS: Laboring women undergoing unscheduled cesarean delivery with epidural anesthesia, and scheduled cesarean delivery with spinal anesthesia were enrolled...
August 2016: International Journal of Obstetric Anesthesia
Mary McCauley, Valentina Actis Danna, Dorah Mrema, Nynke van den Broek
BACKGROUND: Most women experience pain during labour and after childbirth. There are various options, both pharmacological and non-pharmacological, available to help women cope with and relieve pain during labour and after childbirth. In low resource settings, women often do not have access to effective pain relief. Healthcare providers have a duty of care to support women and improve quality of care. We investigated the knowledge and attitudes of healthcare providers regarding the provision of pain relief options in a hospital in Moshi, Tanzania...
November 14, 2018: BMC Pregnancy and Childbirth
K W Arendt, K J Lindley
Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology...
September 27, 2018: International Journal of Obstetric Anesthesia
Ruth Landau, Brendan Carvalho, Cynthia Wong, Richard Smiley, Lawrence Tsen, Marc Van de Velde
No abstract text is available yet for this article.
June 2009: Obstetrics and Gynecology
Kimberly D Gregory, Lisa M Korst, Samia Saeb, Jeanette McCulloch, Naomi Greene, Arlene Fink, Moshe Fridman
BACKGROUND: Under value-based payment programs, patient-reported experiences and outcomes (PROs) can impact hospital and physician revenue. To enable obstetrical providers to improve the childbirth experience, a framework for understanding what women expect and desire during childbirth is needed. OBJECTIVE: To identify key predictors of childbirth hospital satisfaction using the Childbirth Experiences Survey (CBEX). STUDY DESIGN: This study builds on a larger effort that used Patient-Reported Outcomes Management Information System (PROMIS®) methodology to develop a childbirth-specific preliminary PRO item bank...
November 4, 2018: American Journal of Obstetrics and Gynecology
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...
February 2018: Anesthesia and Analgesia
Ahmed Abdelaal Ahmed Mahmoud, Amr Zaki Mansour, Hany Mahmoud Yassin, Hazem Abdelwahab Hussein, Ahmed Moustafa Kamal, Mohamed Elayashy, Mohamed Farid Elemady, Hany W Elkady, Hatem Elmoutaz Mahmoud, Barbara Cusack, Hisham Hosny, Mohamed Abdelhaq
BACKGROUND: Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study. METHODS: This randomized, controlled, double-blind study compared neostigmine and atropine (n = 41) versus a saline placebo (n = 44) for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. The primary outcome was a visual analog scale score of ≤3 at 6, 12, 24, 36, 48, and 72 hours after intervention...
December 2018: Anesthesia and Analgesia
Matthew J A Wilson, Christine MacArthur, Catherine A Hewitt, Kelly Handley, Fang Gao, Leanne Beeson, Jane Daniels
BACKGROUND: About a third of women receiving pethidine for labour pain subsequently require an epidural, which provides effective pain relief but increases the risk of instrumental vaginal delivery. Remifentanil patient-controlled analgesia (PCA) in labour is an alternative to pethidine, but is not widely used. We aimed to evaluate epidural analgesia progression among women using remifentanil PCA compared with pethidine. METHODS: We did an open-label, multicentre, randomised controlled trial in 14 UK maternity units...
August 25, 2018: Lancet
A Bullingham, S Liang, E Edmonds, S Mathur, S Sharma
BACKGROUND: Recent evidence that programmed intermittent epidural bolus (PIEB) improves maternal outcomes encouraged us to change our labour epidural analgesia protocols and investigate if we could achieve similar results in a clinical setting. METHODS: We conducted a prospective, controlled, before-and-after cohort study. Outcomes after labour analgesia delivered by continuous epidural infusion (CEI) with ropivacaine 0.2% and fentanyl 2μg ml-1 were compared with PIEB with patient controlled epidural analgesia (PIEB+PCEA) with ropivacaine 0...
August 2018: British Journal of Anaesthesia
Hana Harazim, Pavel Štourač, Petr Janků, Hana Zelinková, Kamil Frank, Michal Dufek, Petr Štourač
OBJECTIVES: Multiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6-month postpartum period in MS parturients with and without obstetric anesthesia/analgesia. MATERIALS AND METHODS: We retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD-10 code G35 (MS) recorded anytime in their medical history (n = 428)...
September 2018: Brain and Behavior
R Komatsu, B Carvalho, P Flood
BACKGROUND: Prediction models to identify parturients who experience protracted pain, prolonged opioid use, and delayed self-assessed functional recovery are currently inadequate. METHODS: For this study, 213 nulliparous women who planned vaginal delivery were enrolled and assessed daily until they completed three outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery to predelivery level. The primary composite endpoint, 'pain and opioid-free functional recovery' was the time required to reach all three endpoints...
August 2018: British Journal of Anaesthesia
Michael G Richardson, Britany L Raymond, Curtis L Baysinger, Bradley T Kook, David H Chestnut
BACKGROUND: A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness. METHODS: We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic...
July 22, 2018: Birth
Paweł Krawczyk, Piotr Piwowar, Kinga Sałapa, Tomasz Lonc, Janusz Andres
BACKGROUND: The optimal programmed intermittent epidural bolus regimen for labor analgesia remains unknown. Some studies indicate that better drug spread in the epidural space results from greater injection pressure; however, there is a lack of data regarding the maximum pressure generated by epidural bolus injection using different catheters and flow rates. METHODS: We evaluated the flow and pressure characteristics of 11 commonly used epidural catheters combined with 3 different infusion pumps that deliver epidural infusions according to the programmed intermittent epidural bolus regimen...
July 17, 2018: Anesthesia and Analgesia
David P Frey, Melissa E Bauer, Carrie L Bell, Lisa Kane Low, Afton L Hassett, Ruth B Cassidy, Katherine D Boyer, Sam R Sharar
This pilot study investigated the use of virtual reality (VR) in laboring women. Twenty-seven women were observed for equivalent time during unmedicated contractions in the first stage of labor both with and without VR (order balanced and randomized). Numeric rating scale scores were collected after both study conditions. Significant decreases in sensory pain -1.5 (95% CI, -0.8 to -2.2), affective pain -2.5 (95% CI, -1.6 to -3.3), cognitive pain -3.1 (95% CI, -2.4 to -3.8), and anxiety -1.5 (95% CI, -0.8 to -2...
July 11, 2018: Anesthesia and Analgesia
2018-07-20 16:49:05
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