International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1994
The use of a paraspinal field block before epidural analgesia for labour.
The purpose of this study was to determine whether paraspinal field block (PSFB) reduced the pain of epidural needle insertion and the incidence of prolonged post partum back pain in patients receiving epidural analgesia for labour. Patients were randomly assigned to receive local infiltration only with 1-1.5 ml of 1.5% lidocaine (group C, N = 27) or PSFB consisting of an additional 1 ml of 1.5% (group S, N = 30) through the midline skin wheal, on either side of the midline (total 2 ml), near the lamina, before needle insertion. Back pain was measured at the time of needle insertion, before discharge from hospital and 6 weeks post partum, by a blinded observer. ⋯ The cause of post partum back pain is multifactorial and is not dependent on technique of epidural insertion. We conclude that PSFB is ineffective in reducing the pain of epidural needle insertion in labouring patients. Although this study was too small to detect a difference in incidence of late post partum back pain, it appears to be less common than previously reported.
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Int J Obstet Anesth · Jan 1994
A survey of coagulation screening practices in preeclampsia and low-dose aspirin prophylaxis.
In a postal survey of 47 hospitals, consultant anaesthetists were asked their policies for investigating coagulation in parturients with preeclampsia and for those taking aspirin prophylaxis. There was some agreement over policies for mild to moderate preeclampsia. The study also showed that significant numbers of the smaller units encountered aspirin treatment but that there was little consensus on how to respond to it.
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Int J Obstet Anesth · Jan 1993
Neonatal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of opioids has been introduced to improve analgesia during labour and caesarean section. This study was designed to quantify placental transfer of fentanyl and to evaluate neonatal effects of adding fentanyl to 0.5% bupivacaine for epidural anaesthesia in women undergoing elective caesarean section at term. The parturients were randomly allocated to one of four groups of 20, who received either saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Neurologic and adaptive capacity scores were evaluated at 2 and 24 h. Neonates whose mothers received fentanyl had lower scores with regard to supporting reaction at 2 h and active tone at 24 h, when compared to controls (P<0.05), but there were no differences among the groups with regard to the other test criteria in the neurobehavioural test. In conclusion, epidural injection of fentanyl 50-100 microg did not produce depression of the term neonate.