International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1993
Neonatal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of opioids has been introduced to improve analgesia during labour and caesarean section. This study was designed to quantify placental transfer of fentanyl and to evaluate neonatal effects of adding fentanyl to 0.5% bupivacaine for epidural anaesthesia in women undergoing elective caesarean section at term. The parturients were randomly allocated to one of four groups of 20, who received either saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Neurologic and adaptive capacity scores were evaluated at 2 and 24 h. Neonates whose mothers received fentanyl had lower scores with regard to supporting reaction at 2 h and active tone at 24 h, when compared to controls (P<0.05), but there were no differences among the groups with regard to the other test criteria in the neurobehavioural test. In conclusion, epidural injection of fentanyl 50-100 microg did not produce depression of the term neonate.
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Forty patients in whom the dura had been punctured accidentally and 10 patients who had received spinal anaesthesia required epidural blood patching for relief of severe postdural puncture headache (PDPH). Before injecting blood, the epidural pressure was measured, using an epidural catheter as a manometer. ⋯ In 5 patients with inadvertent dural tap, there was a statistically significant decrease (P<0.02) in epidural pressure from 14.9 cm H(2)O (range 11-22 cm H(2)O) before PDPH to 6.9 cm H(2)O (range 5-8.5 cm H(2)O) when they developed PDPH. The benefits of performing an epidural blood patch through a catheter placed in the epidural space are discussed.
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Int J Obstet Anesth · Jan 1993
Haemodynamic effects of the position chosen for the insertion of an epidural catheter.
An epidural catheter may be inserted with the patient either in the flexed left lateral or the sitting position. We have studied, non-invasively, the haemodynamic changes associated with these positions, using the thoracic bio-impedance method (BOMED NCCOM3 Monitor). Maternal arterial pressure and fetal heart rate were monitored simultaneously. ⋯ These changes in SI produced significant reductions in cardiac index (CI) in both groups. In the pregnant patients the CI was significantly lower in the flexed left lateral than in the sitting position (P < 0.01). Consequently maternal systolic blood pressure was lower in the flexed left lateral position (P < 0.01).
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Int J Obstet Anesth · Jan 1993
Maternal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of fentanyl added to 0.5% bupivacaine improves epidural anaesthesia during caesarean section. The present prospective randomized double-blind study sought to determine the lowest effective dose of fentanyl. Eighty healthy women at term were divided into four groups of 20, with each group receiving a different 2 ml study solution: saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Pruritus was the only side-effect (P < 0.05). In conclusion, fentanyl 75 microg was the lowest effective dose for improving quality of analgesia. Onset time was not reduced by the addition of fentanyl.
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Int J Obstet Anesth · Jan 1993
Double-blind evaluation of patient-controlled epidural analgesia during labor.
A double-blind randomized study was designed to compare the efficacy of patient-controlled epidural analgesia (PCEA) with continuous epidural analgesia (CEA) with regards to patient satisfaction with analgesia, analgesic efficacy, and local anesthetic usage. After establishing effective epidural analgesia with 8 ml of 0.25% bupivacaine, 39 parturients were randomized to 1 of 2 groups. The CEA group received a continuous infusion of 12 ml/h of 0.125% bupivacaine. ⋯ The 2 groups also did not differ significantly in terms of patient satisfaction, pain assessment, or total drug usage. However, the PCEA group required significantly fewer supplemental doses (15%) compared with the CEA group (40%). The decreased need for supplemental doses in the PCEA group may suggest a potential advantage in consistency of analgesia and possibly decreased man-power needs.