International journal of obstetric anesthesia
-
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.
-
Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialIncisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study.
This study evaluated efficacy, safety and patient satisfaction with incisional analgesia with a subfascial catheter compared to epidural analgesia for pain relief following caesarean section. ⋯ Incisional local analgesia via a subfascial catheter provided satisfactory pain relief with patient satisfaction comparable to that seen with epidural analgesia. This technique may be a good alternative to the more invasive epidural technique following caesarean section as a component of multimodal pain management.
-
Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialA randomised double-blinded controlled trial of the effect of diluent volume on the efficacy of a single dose of epidural ropivacaine for labour analgesia.
Few studies have systematically investigated the effect of diluent volume on the efficacy of epidural local anaesthetics for labour analgesia and no data are available for ropivacaine. Our aim was to compare epidural ropivacaine given in three different volumes for labour analgesia. ⋯ Under the conditions of this study, within the range of 5-20 mL, the volume and concentration were not significant factors influencing the efficacy of a single 30-mg bolus of epidural ropivacaine given for labour analgesia. This suggests that the most important factor influencing analgesic efficacy was drug mass.
-
Int J Obstet Anesth · Apr 2006
Randomized Controlled Trial Comparative StudyA randomised comparison of 0.5% bupivacaine with a lidocaine/epinephrine/fentanyl mixture for epidural top-up for emergency caesarean section after "low dose" epidural for labour.
When extending a fentanyl-containing, low-dose labour epidural for emergency caesarean section it has been shown that there is no difference in time to surgical readiness between plain bupivacaine 0.5% and mixtures of lidocaine/epinephrine or lidocaine/bupivacaine/epinephrine. However, it is not known whether adding fentanyl to the lidocaine/epinephrine mixture would increase speed of onset or improve the efficacy of the mixture when topping up for an emergency caesarean section. ⋯ The use of a lidocaine/epinephrine/fentanyl mixture conferred no clear statistically significant benefit over the use of plain 0.5% bupivacaine when used to extend fentanyl containing low-dose labour epidural analgesia for emergency caesarean section, but the lidocaine solution is cheaper and less toxic than the alternatives.
-
Int J Obstet Anesth · Jan 2006
Randomized Controlled TrialCombined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery.
Combined spinal-epidural anesthesia balancing low-dose intrathecal bupivacaine/fentanyl and low-dose epidural bupivacaine may be more useful than single-shot spinal anesthesia for cesarean delivery in reducing incidences of adverse effects such as hypotension and nausea and in shortening motor recovery. Combined spinal-epidural anesthesia (n=50) or spinal anesthesia (n=50) was randomly performed in 100 parturients. Intrathecal bupivacaine 6 mg added by fentanyl 20 mug followed after 5 min by 10 mL of 0.25% epidural bupivacaine were used for combined spinal-epidural and intrathecal bupivacaine 9 mg with fentanyl 20 mug for spinal anesthesia. ⋯ Patients in the spinal group had denser motor block in the extremities and a higher incidence of hypotension (P<0.05) and nausea and vomiting (P<0.05). Motor recovery was faster in the combined spinal-epidural group (P<0.001). We concluded that combined spinal-epidural anesthesia using low-dose local anesthetic-opioid spinal anesthesia and routine epidural supplementation before surgery had some potential advantages over single-shot spinal anesthesia in the lower incidences of adverse effects and quicker recovery.