Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Apr 1998
Review[Complications during and after surgery and childbirth where spinal or epidural analgesia is used. Guidelines for safe practice].
When complications and neurological sequelae occur during a spinal or epidural anaesthetic the causes are clearly related to the procedures in the following cases: severe haemodynamic or respiratory derangement, documented needle trauma of nerve fibres, intraspinal haematoma in anticoagulated or heparinized patients, and epidural infection where an infected epidural catheter entry site is documented. A number of well documented cases have been published in which surgery or patient-related pathology were primary causes of "typical" spinal or epidural neurological complications. ⋯ Guidelines are offered for the effective and safe practice of spinal and epidural anaesthesia and pain relief: adequate supervision of trainee anaesthetists, vigilant monitoring for early detection and handling of complications, and trained nurses on surgical wards to monitor and handle patients during epidural analgesia are important. Sufficient readiness for urgent handling of the very rare, but devastating complications of intraspinal bleeding or infection is an absolute necessity.
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Tidsskr. Nor. Laegeforen. · Apr 1998
Comparative Study[Obstetric analgesia in Norwegian hospitals].
We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). ⋯ Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.
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Epidural analgesia in labour using local anaesthetics is very efficient, but the technique has been associated with undesired motor block and an increased use of instrumental deliveries. A new epidural analgesia technique, using a combination of low-dose local anaesthetics and opioids (fentanyl and sufentanil), has recently come into practice. The new epidural technique provides excellent analgesia, minimises motor block, allows the mother to ambulate, and minimises the need for instrumental delivery. ⋯ We are of the opinion that all pregnant women should be given detailed information about both the benefits and the possible side-effects of epidural analgesia in good time before they go into labour. This will allow them to participate more actively in deciding whether or not to use analgesia during labour. Optimal use of epidural analgesia not only depends on the availability of a 24-hour anaesthesia service, but also on adequate knowledge and the cooperation and enthusiasm of all those involved, namely midwives, obstetricians and anaesthesiologists.