International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1994
Pain relief after caesarean section: comparison of different techniques of morphine administration.
We have studied postoperative pain relief after different techniques of morphine administration given in addition to bupivacaine 15 mg during spinal anaesthesia for caesarean section. In group A, morphine was given both intravenously (10 mg) and orally (30 mg slow release MST) at the end of surgery and continued orally at 8-hourly intervals for 24 h. ⋯ Pruritus was, on the other hand, observed in 48% of patients of group B compared to 7% of the patients of group A. This study suggests that adding 80 microg of morphine to the local anaesthetic used in spinal anaesthesia for caesarean section is a simple procedure that gives excellent results in term of reliability, duration of analgesia and safety.
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Int J Obstet Anesth · Oct 1994
Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia.
Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.
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A 32-year-old patient developed pseudo-obstruction of the large bowel following elective caesarean section. The association of this rare postoperative complication with anaesthesia is discussed. ⋯ The reported mortality varies from 14-30% rising to 40-50% if there is caecal perforation. The underlying mechanism is thought to be an imbalance of the autonomic nervous system.
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Int J Obstet Anesth · Oct 1994
Epidural lidocaine versus 2-chloroprocaine for fetal distress requiring urgent cesarean section.
Chloroprocaine is a local anesthetic widely used for the urgent cesarean delivery of a distressed fetus in an mother with a epidural catheter because of its quick onset and short half-life. However, chloroprocaine has disadvantages that include decreased effectiveness of subsequently administered epidural amides and narcotics. ⋯ A retrospective review revealed that though the drug administration to incision time was significantly faster (P < 0.005) for 3% chloroprocaine, both 3% chloroprocaine and 1.5% lidocaine were clinically effective. There were no differences in neonatal Apgar scores or neonatal umbilical cord pH values between the two treatment populations, offering lidocaine as an attractive alternative to chloroprocaine.