International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
Case ReportsFoot drop after spinal anesthesia in a patient with a low-lying cord.
Damage to the spinal cord/conus medullaris due to incorrect identification of the lumbar space is a known complication of lumbar puncture. However, damage to a low-lying cord using an appropriate interspace is extremely rare. ⋯ She developed right foot drop immediately after surgery, which gradually recovered over the next 10 months. Magnetic resonance imaging revealed a low lying cord with a fatty filum terminale and intramedullary T2 hyperintensity, suggestive of needle damage.
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Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialPatient-controlled epidural analgesia: the role of epidural fentanyl in peripartum urinary retention.
Urinary bladder function is impaired during labor and delivery, predisposing to urinary retention. The effect of low-dose epidural opioid on bladder function remains unclear. We tested the hypothesis that adding low-dose fentanyl to epidural ropivacaine for patient-controlled labor analgesia does not promote urinary retention. ⋯ Addition of fentanyl to patient-controlled epidural analgesia did not increase the risk of urinary retention. Ultrasound measurements were effective and reliable in assessing urinary bladder volumes during labor.
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Int J Obstet Anesth · Jul 2006
ReviewA survey of labor patient-controlled epidural anesthesia practice in California hospitals.
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals. ⋯ Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.
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Int J Obstet Anesth · Jul 2006
An analysis of the need for anesthetic interventions with differing concentrations of labor epidural bupivacaine: an observational study.
Labor epidural analgesia techniques using lower concentrations of bupivacaine are designed to maintain pain control with fewer side effects such as hypotension and motor block. However, the increase in sensation may allow breakthrough pain resulting in the need for additional interventions. We examined the number of interventions, both for analgesia and for treatment of side effects, required when using three concentrations of bupivacaine. ⋯ Neither the total interventions nor intervention rate per hour varied significantly with the concentrations of bupivacaine used in this study. Lower concentrations produced fewer side effects including hypotension, while the higher concentration resulted in less breakthrough pain.
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Int J Obstet Anesth · Jul 2006
Case ReportsLabor epidural placement in a woman with a cervical spinal cord stimulator.
A 37-year-old female, gravida 1 para 0, in active labor at term, with a cervical spinal cord stimulator in situ, presented for epidural analgesia for labor. She had received the cervical spinal cord stimulator some 30 months before, to treat chronic regional pain syndrome I. She was taking no medication, and was thin but otherwise healthy. ⋯ Her labor and delivery proceeded uneventfully. The spinal cord stimulator continued to function well throughout the entire process. She noticed that the feeling in her right hand returned to baseline after the delivery.