International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2000
Randomized Controlled Trial Clinical TrialA randomised, double-blind comparison of subarachnoid and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique.
We have compared the quality of analgesia and incidence of side-effects from subarachnoid and epidural diamorphine for caesarean section, as part of a combined spinal-epidural technique. Sixty patients were studied in a randomised, double-blind, double-dummy assessment. The doses of diamorphine reflect current practice in our hospital and are close to optimal. ⋯ Postoperative nausea and vomiting were uncommon; 83% of patients in group 1 and 77% in group 2 had none. Subarachnoid and epidural diamorphine provided similar quality analgesia with a low incidence of emetic symptoms. However, pruritus was more common and more severe after subarachnoid diamorphine.
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Int J Obstet Anesth · Oct 2000
Anaesthesia for emergency caesarean section in a parturient with bleeding placenta praevia and a potentially malignant hyperthermia-susceptible fetus.
A parturient who was 35 weeks' pregnant by her husband who was known to be susceptible to malignant hyperthermia, required anaesthesia for caesarean section for bleeding placenta praevia. The patient was considered to be haemodynamically stable and the procedure was carried out uneventfully under subarachnoid block. Anaesthesia was conducted as for an individual who is susceptible to malignant hyperthermia. The combination of the potential susceptibility to malignant hyperthermia of the fetus, and the problems of bleeding placenta praevia, produced an unusual clinical situation with potential conflict of interests when choosing the anaesthetic technique.
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Int J Obstet Anesth · Oct 2000
Randomized Controlled Trial Clinical TrialPostoperative intraspinal opioid analgesia after caesarean section; a randomised comparison of subarachnoid morphine and epidural pethidine.
A randomised, blinded clinical trial was performed to evaluate intraspinal opioid analgesic techniques after caesarean section. Healthy term parturients having elective caesarean section under combined spinal-epidural anaesthesia were allocated to one of three groups. Postoperative analgesia, including non-steroidal anti-inflammatory drugs, was provided using either pethidine patient-controlled epidural analgesia (group PCEA) or subarachnoid morphine 200 microg, the latter supplemented as required with patient-controlled intravenous pethidine (group SMPCIA) or oral paracetamol and codeine (group SMO). ⋯ Patient satisfaction was similar, although women in group SMO were least likely to choose this approach again (P<0.05). We concluded that all three techniques provided effective analgesia for a prolonged period postoperatively. Better pain relief, but more opioid-related side effects, resulted from subarachnoid morphine 200 microg, and re-evaluation of reduced doses of subarachnoid morphine may be warranted.
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Int J Obstet Anesth · Oct 2000
A survey of regional analgesia and anaesthesia for obstetrics in selected countries in the Far East.
A survey was conducted in several countries in the Far East in an attempt to determine the practice of obstetric analgesia and anaesthesia there. Survey forms were sent to a total of 11 countries but in the end responses from only four countries were able to provide useful information. Responses from Singapore, Hong Kong, Taiwan and Malaysia covered between 44.9% (Singapore) and 24.6% (Malaysia) of their countries' total deliveries in 1997 and were thought to be adequate to give an impression of the obstetric analgesia and anaesthesia services in their respective countries, although this would not necessarily be completely accurate. From our survey, we found that the availability of regional analgesia for labour paralleled the economic status of the country and that a significant number of caesarean sections are conducted under regional anaesthesia, mainly spinals.