International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyComparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia.
Several studies have been performed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus. We aimed to compare the efficacy and side effects of epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl at low concentrations. ⋯ We found no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyAutomated regular boluses for epidural analgesia: a comparison with continuous infusion.
Intermittent epidural bolus dosing is a method of drug delivery that can prolong the duration of labour analgesia induced by a combined spinal epidural (CSE). In this randomized, double-blinded study, we compared the analgesic efficacy of two drug delivery systems: regular intermittent epidural boluses and continuous epidural infusion and assessed the incidence of breakthrough pain after CSE. ⋯ Automated regular bolus delivery of epidural analgesia when compared with continuous infusion decreased the incidence of breakthrough pain and increased maternal satisfaction. In a busy obstetric unit, this may also serve to decrease the anesthetists' workload.
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyIs ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients?
Hypotension following spinal anaesthesia for caesarean section may result in maternal nausea and vomiting and decreased uteroplacental blood flow with possible fetal acidaemia. Numerous methods have been tried to minimise hypotension. In developing countries where resources are limited, this study aimed to compare a standard infusion of ephedrine with traditional prehydration to prevent spinal hypotension. ⋯ Prophylactic ephedrine given by standard infusion set was more effective than crystalloid prehydration in the prevention of hypotension during spinal anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Clinical Trial"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia. ⋯ These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.
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Int J Obstet Anesth · Jul 2005
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural ropivacaine 0.75% and bupivacaine 0.5% with fentanyl for elective caesarean section.
Early studies suggested that ropivacaine had clinical advantages over bupivacaine with respect to cardiotoxicity and motor block, and that it was suitable for epidural caesarean section. This study was set up to compare epidural 0.75% ropivacaine with a popular bupivacaine/fentanyl mixture for elective caesarean section. ⋯ This study suggests that epidural 0.75% ropivacaine without opioid may be used as an alternative to bupivacaine 0.5% with fentanyl for elective caesarean section, but it does not induce anaesthesia any faster and may result in a denser, more prolonged, motor block.