Articles: analgesia.
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Meta Analysis
Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women.
The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery. ⋯ Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.
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Whether epidural analgesia is a better method than parenteral opioids for postoperative pain control remains controversial. ⋯ Epidural analgesia, regardless of analgesic agent, location of catheter placement, and type and time of pain assessment, provided better postoperative analgesia compared with parenteral opioids.
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Anesthesia and analgesia · May 2003
Meta AnalysisEpidural ropivacaine versus bupivacaine for labor: a meta-analysis.
Numerous studies have compared ropivacaine with bupivacaine for labor analgesia. Early studies suggested that obstetrical and some neonatal outcomes were improved when ropivacaine was used. We systematically reviewed and combined the results of the randomized controlled trials that compared ropivacaine with bupivacaine to determine whether or not there was a difference in these outcomes. We searched electronic databases and journals for randomized controlled trials composed of laboring parturients. The primary outcome was the incidence of spontaneous vaginal delivery. We examined other obstetrical, neonatal, and analgesic outcomes. Where possible, these were combined by using metaanalytic techniques and random effects modeling. We found 23 randomized controlled trials composed of 1043 patients receiving ropivacaine and 1031 receiving bupivacaine. There was no significant difference in the incidence of spontaneous vaginal delivery (odds ratio, 1.17; 95% confidence interval, 0.98-1.41; P = 0.12) or any of the other outcomes. Although more studies reported a more frequent incidence of motor block with bupivacaine, the results were heterogeneous and therefore not combined. We conclude that there is no statistically significant difference between the two drugs in the incidence of any obstetrical or neonatal outcome. Further studies using clinically appropriate concentrations of drugs are required to determine whether or not there is a difference in the incidence of motor block. ⋯ This metaanalysis of 23 randomized controlled trials shows that both ropivacaine and bupivacaine provide excellent labor analgesia. There was no significant difference between the two drugs in mode of delivery, maternal satisfaction, or neonatal outcomes. Whether or not there is a difference in motor block at clinically relevant doses is unresolved.
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Review Meta Analysis Comparative Study
Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia.
To assess the effect of epidural versus systemic labour analgesia on funic acid-base status at birth. ⋯ Umbilical artery pH is influenced by maternal hyperventilation. Base excess is therefore a better index of metabolic acidosis after labour. Epidural analgesia is associated with improved neonatal acid-base status, suggesting that placental exchange is well preserved in association with maternal sympathetic blockade and good analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits to neonatal acid-base status.
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Ann Fr Anesth Reanim · Nov 2002
Meta Analysis[Use of ropivacaine for peridural postoperative analgesia].
To describe pharmacology and toxicology of ropivacaine. To assess the clinical efficacy of ropivacaine when used for postoperative epidural analgesia and to provide recommendations for clinical practice. ⋯ Epidural ropivacaine combined with opioid provide good postoperative pain relief. Reduction in the incidence of motor blockade and safe toxicological profile make this local anaesthetic a suitable alternative of bupivacaine for postoperative epidural analgesia.