Articles: analgesia.
-
We report a case of a parturient with peroneal muscular atrophy-Charcot-Marie-Tooth disease type 1 (CMT)-who received epidural analgesia for labour. The effects of pregnancy and labour on the course of CMT are reviewed, together with the current literature on the provision of epidural and general anaesthesia in this disease. ⋯ Epidural analgesia, after thorough discussion with the patient, may be offered to parturients with CMT.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour.
We have studied the use of clonidine combined with low doses of sufentanil and bupivacaine in 45 parturients requiring extradural analgesia for the first stage of labour, in a double-blind, randomized study. We gave 0.0625% bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10 micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150 micrograms (1 ml). We compared the quality (VAS scores) and duration of analgesia, motor block, maternal haemodynamic state (mean arterial pressure and heart rate) and fetal and maternal side effects. ⋯ Analgesia was associated with a reduction in mean arterial pressure with clonidine. However, these adverse side effects were of minor clinical importance regardless of the extradural clonidine dose, except for a high incidence of fetal heart tracing abnormalities when clonidine 150 micrograms was used. These effects associated with a limited effect on analgesia may curtail the widespread use of clonidine as an adjunct to extradural 0.0625% bupivacaine with sufentanil 10 micrograms during labour.
-
Anesthesia and analgesia · Oct 1996
ReviewPostoperative epidural opioid analgesia: what are the choices?
The administration of hydrophilic opioids via a continuous infusion results in selective spinal analgesia with a low incidence of side effects. Lipophilic opioids may also be associated with spinal effects. However, the doses required to produce postoperative analgesia also produce plasma concentrations within the MEAC. ⋯ Regardless of the mechanism of action, epidural administration of lipophilic opioids may offer no clinical advantages over the IV route. Notwithstanding, epidural administration of small doses of lipophilic opioids in combination with local anesthetics may offer significant clinical advantages over systemic administration of opioids alone. Dose-ranging studies will be necessary to determine the ideal concentrations of opioids and local anesthetics, as well as the ratios of the two drugs to obtain optimal analgesia with minimal incidence of side effects.
-
Int J Obstet Anesth · Oct 1996
Randomized Controlled Trial Clinical TrialA comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section.
In a double-blind investigation, 40 women undergoing elective lower segment caesarean section were randomly divided into two groups. Group I (n = 20) received spinal anaesthesia with 2.0 ml hyperbaric 0.5% bupivacaine using a single space combined spinal epidural technique. Group II (n = 20) received epidural anaesthesia with a local anaesthetic mixture consisting of 0.5% bupivacaine plain 10 ml and 2% lignocaine plain 10 ml to which was added 0.1 ml of adrenaline 1 in 1000 and 2 ml of 8.4% sodium bicarbonate. ⋯ There was no difference between the two groups in the quality of analgesia or the incidence of hypotension and nausea. The relatively rapid onset of the pH adjusted epidural solution may provide an attractive alternative to spinal anaesthesia. Moreover, this study underlines the important role of pH adjusted epidural solutions in parturients progressing to emergency caesarean section with epidural catheters previously inserted for labour analgesia.