International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2019
ReviewSystemic adjunct analgesics for cesarean delivery: a narrative review.
It is critical to adequately treat postoperative cesarean delivery pain. The use of parenteral or neuraxial opioids has been a mainstay, but opioids have side effects that can be troubling and the opioid crisis in the United States has highlighted the necessity to utilize analgesics other than opioids. Other analgesic options include neuraxial analgesics, nerve blocks such as the transversus abdominis plane block, and non-opioid parenteral and oral medications. The goal of this article is to review non-opioid systemic analgesic adjuncts following cesarean delivery, focusing on their efficacy and side effects as well as their impact on reduction of opioid requirements after surgery.
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Int J Obstet Anesth · Nov 2019
Observational StudyLabor epidural analgesia onset time and subsequent analgesic requirements: a prospective observational single-center cohort study.
We investigated the correlation between lumbar epidural analgesia onset time and pain intensity at 60 and 120 min after initiation. ⋯ There was a correlation between the onset time of lumbar epidural analgesia during labor and the pain score 60 min later but this had disappeared by 120 min.
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Int J Obstet Anesth · Nov 2019
Case ReportsSuccessful treatment of a recurrent post-dural puncture headache with an epidural blood patch 18 months after the initial dural puncture.
Inadvertent dural puncture is a recognised complication of epidural insertion. Parturients are at increased risk of developing a post-dural puncture headache, which can be debilitating for a mother caring for a newborn infant. ⋯ We present the case of a woman with a recurrent post-dural puncture headache who was successfully treated with an epidural blood patch 18 months after the initial dural puncture. Patients who develop post-dural puncture headaches may remain symptomatic for some time and an epidural blood patch may be beneficial, following appropriate investigation.