Clinics in perinatology
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Clinics in perinatology · Sep 2013
ReviewNonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations.
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. ⋯ Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.
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Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery.
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A supportive medical team should be well informed on the various pharmacologic and nonpharmacologic modalities of coping with or mitigating labor pain to appropriately support and respectfully care for parturients. Using the methodical rigor of previously published Cochrane systematic reviews, this summary evaluates and discusses the efficacy of nonpharmacologic labor analgesic interventions.
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Clinics in perinatology · Sep 2013
ReviewChronic opioid use during pregnancy: maternal and fetal implications.
Current trends in the United States suggest that chronic narcotic use has increased in reproductive aged women over the past 10 years. Regular exposure to such substances during pregnancy has maternal and fetal implications. ⋯ A multidisciplinary, collaborative approach is highly recommended. This review discusses usage of narcotic medications, associated maternal and fetal risks, and management strategies for the antepartum, intrapartum, and postpartum periods.
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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.