International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2012
Randomized Controlled Trial Comparative StudyA randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia.
Intrathecal morphine is an effective analgesic post-cesarean delivery; however, it may be contraindicated or unsuitable in some patients. We compared the efficacy and side effects of intrathecal morphine with an ultrasound-guided transversus abdominis plane (TAP) block in a randomized, controlled, double-blinded trial. The primary outcome was the morphine equivalents dose used in the first 24 h post-surgery. Secondary outcomes were pain scores and side effects, including pruritus, sedation, nausea and vomiting. ⋯ In this trial, the TAP block was associated with greater supplemental morphine requirements and higher pain scores than intrathecal morphine but fewer opioid-related side effects. The TAP block may be a reasonable alternative when intrathecal morphine is contraindicated or not appropriate.
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It is clear from animal studies that commonly used anesthetic agents affect early brain development both histologically and functionally. With human epidemiologic evidence suggesting an association between anesthesia and surgery early in life and late-onset learning disabilities, investigators have focused their attention on the subtle long-term effects of anesthesia exposure. Most obstetric anesthesia studies, however, have focused on either the teratogenic effects of anesthetic agents in the first trimester or on the neonatal status immediately after delivery. ⋯ Of concern though, is that these events are easily perturbed by environmental and pharmacological influences. New research studies have raised significant questions about the fetal impact of maternal anesthesia for non-obstetric and fetal surgery. This review summarizes the major findings in the field of developmental neurotoxicity of anesthetic agents, discusses the susceptibility of the fetal brain to anesthetic effects in a trimester-specific style, and outlines the pitfalls in extrapolating animal research to humans.
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Int J Obstet Anesth · Apr 2012
Pharmacokinetics of a loading dose of intravenous paracetamol post caesarean delivery.
The postpartum period affects drug disposition, but data of intravenous paracetamol loading dose pharmacokinetics immediately following caesarean delivery have not yet been reported. ⋯ Pharmacokinetics of intravenous paracetamol have been estimated following caesarean delivery. Although limited to a loading dose shortly after surgery, the results are clinically relevant since this is the first description in this patient population. These data provide evidence on which to base further integrated pharmacokinetic/pharmacodynamic studies in peripartum analgesia.
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Int J Obstet Anesth · Apr 2012
The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor.
Objective pain assessment that is not subject to influences from either cultural or comprehension issues is desirable. Analysis of heart rate variability has been proposed as a potential method. This pilot study aimed to assess the performance of the PhysioDoloris™ analgesia monitor which calculates an Analgesia Nociception Index derived from heart rate variability. It was compared with visual analogical pain scores. ⋯ The Analgesia Nociception Index has an inverse linear relationship with visual analogical pain scores. Further studies are necessary to confirm the results of this pilot study and to look at the influence of epidural analgesia on the Analgesia Nociception Index.