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Labour Analgesia

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242 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
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...
August 29, 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
Allana Munro, Ronald B George, Victoria M Allen
PURPOSE: The incidence of epidural top-ups received in the second stage of labour in nulliparous women and the obstetrical and neonatal implications associated with these boluses are explored in this retrospective observational study. We hypothesized that an epidural top-up in the second stage of labour reduces operative deliveries by resolving inadequate analgesia. METHODS: A population-based cohort analysis was performed using perinatal data from 1 January 2013 through 31 December 2014...
July 9, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
David M Haas, Sarah Morgan, Karenrose Contreras, Savannah Enders
BACKGROUND: Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane review first published in 2010 and subsequently updated in 2012, and twice in 2014...
July 17, 2018: Cochrane Database of Systematic Reviews
Alessandro Favilli, Antonio Simone Laganà, Ugo Indraccolo, Alessandra Righi, Onofrio Triolo, Maria D' Apolito, Sandro Gerli
OBJECTIVE: The aim of this study was to assess women preference about pain and duration of labour applying a standardized questionnaire. STUDY DESIGN: A prospective multicentre large cohort study was carried out in two different University Hospitals. A standardized questionnaire was proposed before active labour and the day after delivery in order to investigate whether women preferred low pain intensity for a longer labour duration or greater pain intensity for a shorter labour duration...
September 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Carolyn F Weiniger, Seden Akdagli, Elliot Turvall, Lisa Deutsch, Brendan Carvalho
BACKGROUND: Intrathecal morphine provides excellent analgesia after cesarean delivery; however, respiratory events such as apnea, bradypnea, and hypoxemia have been reported. The primary study aim was to estimate the number of apneas per subject, termed "apnea alert events" (AAEs) defined by no breath for 30-120 seconds, using continuous capnography in women who underwent cesarean delivery. METHODS: We performed a prospective, observational study with institutional review board approval of women who underwent cesarean delivery with spinal anesthesia containing 150-µg intrathecal morphine...
June 28, 2018: Anesthesia and Analgesia
Michihisa Shiro, Katsutoshi Nakahata, Sawako Minami, Tomoyuki Kawamata, Kazuhiko Ino
AIM: We compared the perinatal outcomes of vaginal delivery with epidural analgesia initiated at the early versus late phase in a Japanese population. METHODS: Women enrolled in this retrospective cohort study received intrapartum analgesia via combined spinal epidural analgesia after labor onset between May 2010 and August 2015. We compared the perinatal outcomes between two different timings of epidural analgesia: at the early phase (≤3 cm cervical dilatation) and the late phase (≥4 cm) or at the new definition-based early phase (≤5 cm) and late phase (≥6 cm)...
August 2018: Journal of Obstetrics and Gynaecology Research
Jessica L Booth, Emily E Sharpe, Timothy T Houle, Lynnette Harris, Regina S Curry, Carol A Aschenbrenner, James C Eisenach
We know very little about the change in pain in the first 2 months after surgery. To address this gap, we studied 530 women scheduled for elective cesarean delivery who completed daily pain diaries for two months after surgery via text messaging. Over 82% of subjects missed fewer than 10 diary entries and were included in the analysis. Completers were more likely to be Caucasian, non-smokers, and with fewer previous pregnancies than non-completers. Daily worst pain intensity ratings for the previous 24 hours were fit to a log(time) function and allowed to change to a different function up to 3 times according to a Bayesian criterion...
June 13, 2018: Pain
Whitney Wood
While pain in childbirth is a universal, cross-cultural, biological reality, individual experiences and perceptions of this pain are historically and culturally specific. At the turn of the 20th century-a key period in terms of both the medicalisation of birth and the professionalisation of obstetrics in the Canadian context-Canadian physicians understood and conceptualised 'birth pangs' in a number of varying (and at times competing) ways. Throughout the 19th century, doctors emphasised the broader utility of pain as a diagnostic tool and a physiologically necessary part of the birthing process...
June 2018: Medical Humanities
Sharon Orbach-Zinger, Ruth Landau, Atara Davis, Oren Oved, Liron Caspi, Shlomo Fireman, Shai Fein, Alexander Ioscovich, Danielle Bracco, Moshe Hoshen, Leonid A Eidelman
BACKGROUND: The effect of labor epidural analgesia (LEA) on successful breastfeeding has been evaluated in several studies with divergent results. We hypothesized that LEA would not influence breastfeeding status 6 weeks postpartum in women who intended to breastfeed in an environment that encourages breastfeeding. METHODS: In this prospective observational cohort study, a total of 1204 women intending to breastfeed, delivering vaginally with or without LEA, were included; breastfeeding was recorded at 3 days and 6 weeks postpartum...
May 25, 2018: Anesthesia and Analgesia
(no author information available yet)
Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad...
July 2018: Obstetrics and Gynecology
E M E Bos, J Haumann, M de Quelerij, W P Vandertop, C J Kalkman, M W Hollmann, P Lirk
Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spinal haematomas and abscesses associated with central neuraxial blocks. Extracted data included patient characteristics, symptoms, treatment, and outcome. We analysed 409 reports, including 647 patients (387 patients with spinal haematoma and 260 patients with spinal abscess)...
April 2018: British Journal of Anaesthesia
Silvia Poma, Luigia Scudeller, Chiara Verga, Giorgio Mirabile, Barbara Gardella, Federica Broglia, Maria Ciceri, Marinella Fuardo, Simona Pellicori, Maddalena Gerletti, Silvia Zizzi, Elena Masserini, Maria Paola Delmonte, Giorgio Antonio Iotti
BACKGROUND: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal-epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal-epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal-epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes...
May 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
2018-05-19 21:58:22
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