International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2001
A survey of epidural technique and accidental dural puncture rates among obstetric anaesthetists.
Five hundred UK obstetric anaesthetists were surveyed to investigate retrospectively the relationship between experience, rotation of the epidural needle within the epidural space, choice of loss-of-resistance agent and accidental dural puncture (ADP) rate. Responses were received from 390 (78%) of the members surveyed. Anaesthetists with more than 15 years' experience are more likely to perform an epidural with the patient in the lateral position (P < 0.001), use loss-of-resistance to air to detect the epidural space (P < 0.001) and rotate the epidural needle after identifying the epidural space (P = 0.001) when compared to those of less experience. ⋯ There are three components that can alter from case to case; patient positioning, loss-of-resistance agent and needle rotation. Loss-of-resistance agent and patient positioning in isolation did not significantly influence ADP rate. This study suggests that the combination of practising lateral patient positioning, loss-of-resistance to saline and non-rotation of the epidural needle significantly reduces ADP rate (P = 0.035).
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Int J Obstet Anesth · Jan 2001
Long-term morbidity following dural puncture in an obstetric population.
Immediate and long-term symptoms, particularly headache, are recognised complications of dural puncture. To investigate long-term symptoms, a case-controlled retrospective questionnaire study was performed. The questionnaire was sent to 194 mothers who had suffered either accidental dural puncture during the placement of an epidural catheter or had developed a significant headache following spinal anaesthesia. ⋯ There was increased reporting of new long-term headache and neckache in the spinal study group and an increased reporting of new long-term backache in the accidental dural puncture group compared to the epidural controls. These symptoms had a significant impact upon the mother's daily life and in some instances lasted for years. Disappointingly, although epidural blood patching was beneficial in the short term, it failed to produce any reduction in the incidence of long-term symptoms.
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Int J Obstet Anesth · Jan 2001
Randomized Controlled Trial Clinical TrialA comparison of bupivacaine-fentanyl-morphine with bupivacaine-fentanyl-diamorphine for caesarean section under spinal anaesthesia.
In a randomised double-blind trial, postoperative analgesia and side effects of intrathecal morphine 0.1 mg and intrathecal diamorphine 0.25 mg were compared. Sixty women were randomised to receive intrathecal injection of 12.5 mg hyperbaric bupivacaine and 12.5 microg fentanyl with either morphine 0.1 mg (group M), or diamorphine 0.25 mg (group D). All women received 100 mg diclofenac rectally at the end of surgery and were given intravenous morphine via a patient controlled analgesia (PCA) system. ⋯ There was no significant difference between the groups in the number of women vomiting in the 24-h period. The two groups were comparable for pruritus and drowsiness. We conclude that 0.25 mg subarachnoid diamorphine is a suitable alternative to 0.1 mg morphine for post caesarean section analgesia.
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Int J Obstet Anesth · Oct 2000
Randomized Controlled Trial Clinical TrialA randomised, double-blind comparison of subarachnoid and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique.
We have compared the quality of analgesia and incidence of side-effects from subarachnoid and epidural diamorphine for caesarean section, as part of a combined spinal-epidural technique. Sixty patients were studied in a randomised, double-blind, double-dummy assessment. The doses of diamorphine reflect current practice in our hospital and are close to optimal. ⋯ Postoperative nausea and vomiting were uncommon; 83% of patients in group 1 and 77% in group 2 had none. Subarachnoid and epidural diamorphine provided similar quality analgesia with a low incidence of emetic symptoms. However, pruritus was more common and more severe after subarachnoid diamorphine.
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Int J Obstet Anesth · Oct 2000
A survey of regional analgesia and anaesthesia for obstetrics in selected countries in the Far East.
A survey was conducted in several countries in the Far East in an attempt to determine the practice of obstetric analgesia and anaesthesia there. Survey forms were sent to a total of 11 countries but in the end responses from only four countries were able to provide useful information. Responses from Singapore, Hong Kong, Taiwan and Malaysia covered between 44.9% (Singapore) and 24.6% (Malaysia) of their countries' total deliveries in 1997 and were thought to be adequate to give an impression of the obstetric analgesia and anaesthesia services in their respective countries, although this would not necessarily be completely accurate. From our survey, we found that the availability of regional analgesia for labour paralleled the economic status of the country and that a significant number of caesarean sections are conducted under regional anaesthesia, mainly spinals.