International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2010
Randomized Controlled Trial Comparative StudyPerineal infiltration with lidocaine 1%, ropivacaine 0.75%, or placebo for episiotomy repair in parturients who received epidural labor analgesia: a double-blind randomized study.
Episiotomies are performed in approximately 20% of vaginal deliveries and may result in postpartum pain. Perineal infiltration with lidocaine during the episiotomy is widely used, despite an early study showing no difference when compared with saline. Ropivacaine has increasingly been used in the obstetric setting, although not for episiotomies. We sought to compare the analgesic efficacy of ropivacaine, lidocaine or saline for perineal infiltration before repair of a mediolateral episiotomy in patients who delivered with epidural labor analgesia. ⋯ For the first 24 h, perineal infiltration of ropivacaine, lidocaine, and saline were equivalent in producing post-episiotomy analgesia.
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Int J Obstet Anesth · Jul 2010
Randomized Controlled TrialSensory testing of spinal anaesthesia for caesarean section: differential block and variability.
The aim of this study was to determine if sensory block following spinal anaesthesia, measured with a range of devices, corresponded to the hierarchy of nerve fibre size in the area of differential block, and to compare the distribution and variability of recorded measurements. ⋯ Sensory fibre hierarchy could be identified. Tests for light touch showed the least variability. More expensive tests do not appear to have any advantage over the least expensive test, cotton wool.
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Int J Obstet Anesth · Jul 2010
Clinical TrialAn observational study of skin conductance monitoring as a means of predicting hypotension from spinal anaesthesia for caesarean delivery.
Hypotension after spinal anaesthesia is a common and important complication at caesarean delivery. Skin conductance monitoring has been shown to predict post-spinal hypotension in elderly patients and may be a rapid, non-invasive means of predicting risk in the obstetric population. ⋯ In contrast to a previous report in elderly patients, we were unable to demonstrate a significant relationship between baseline sympathetic tone, measured by skin conductance, and hypotension following spinal anaesthesia in women undergoing elective caesarean delivery.
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The administration of oxytocic drugs during caesarean section is an important intervention to prevent uterine atony or treat established postpartum haemorrhage. Considerable past and current research has shown that these agents have a narrow therapeutic range. A detailed knowledge by anaesthetists of optimal doses and side effects is therefore required. ⋯ In view of receptor desensitisation, second line agents may be required, namely ergot alkaloids and prostaglandins. This review examines the adverse haemodynamic and side effects, and methods for their limitation. An approach to dosing and choices of agent for the limitation of postpartum haemorrhage is suggested.