International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jan 2007
Randomized Controlled TrialDose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard.
This double-blind randomised controlled trial investigated the most appropriate dose of intrathecal diamorphine to use with high-dose diclofenac as part of a multimodal analgesic regimen for caesarean section under subarachnoid block. We also wished to establish whether it was possible to satisfy the Royal College of Anaesthetists postoperative pain audit recommendation for this patient group. ⋯ We found that for elective caesarean section under subarachnoid block with high dose diclofenac, analgesia was optimal with 300 microg of intrathecal diamorphine. Even the highest dose of intrathecal diamorphine did not achieve the Royal College of Anaesthetists postoperative audit target that 90% of patients should have a pain score of no more than 3/10. We believe that this target is too arduous.
-
Int J Obstet Anesth · Jan 2007
Randomized Controlled Trial Comparative StudyA randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery.
Spinal anesthesia for cesarean delivery is commonly associated with hypotension and nausea and vomiting, and preload with crystalloid or colloid solution is widely recommended. Low-dose spinal via the combined spinal-epidural technique appears to cause less hypotension and nausea and vomiting. The aim of this study was to investigate whether the combined use of colloid preload and combined spinal-epidural technique might further reduce the rates of these symptoms. ⋯ Colloid preload and low-dose spinal anesthesia alone or in combination lowered the incidences of hypotension and nausea. However, the combination of two methods failed to demonstrate further decreases in the incidence of the symptoms compared to the colloid-spinal anesthesia or crystalloid-combined spinal-epidural anesthesia groups.
-
Int J Obstet Anesth · Jan 2007
Randomized Controlled TrialEffect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour.
The aim was to assess the effect of epidural sufentanil on relative analgesic potencies of epidural bupivacaine, ropivacaine and levobupivacaine by determining the minimum local analgesic concentrations during labour. ⋯ Local anaesthetic requirements for bupivacaine, levobupivacaine and ropivacaine follow an analgesic potency hierarchy. Any potency differences are small when compared to the effect of sufentanil, which resulted in a four-fold reduction in local anaesthetic requirements. Sufentanil may also enhance the potency differences between bupivacaine and the two S-enantiomer agents.
-
Int J Obstet Anesth · Oct 2006
Randomized Controlled TrialA randomised trial comparing 5 mL/kg and 10 mL/kg of pentastarch as a volume preload before spinal anaesthesia for elective caesarean section.
Colloid solutions are more effective at preventing hypotension than crystalloids when used as a volume preload before caesarean delivery under spinal anaesthesia. The ideal volume to infuse has not been established. ⋯ Pentastarch, 10 mL/kg is more effective than 5 mL/kg at preventing hypotension following spinal anaesthesia for caesarean delivery.
-
Int J Obstet Anesth · Oct 2006
Randomized Controlled TrialUltra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial.
We wished to investigate the feasibility of an ultra low-dose combined spinal-epidural technique in providing surgical anesthesia for uncomplicated cesarean deliveries in a randomized, double-blind controlled trial. ⋯ We conclude that this technique results in a significantly lower incidence of maternal hypotension and has a role in high-risk parturients in whom maintenance of stable hemodynamics is imperative.