Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Lignocaine test dose to detect intravenous injection.
The accidental intravascular injection of bupivacaine or etidocaine epidurally has resulted in several maternal deaths. To be effective, a test dose must allow detection of intravenous catheter placement and prevent accidental intravenous injection. This study was designed to determine the dose of lignocaine required for this purpose. ⋯ At 1 min intervals the patients were asked about subjective symptoms produced by this 'test dose'. In group 2 only 50% of patients reported a positive test dose, whereas in the patients of group 3, a significantly greater percentage (95%) had a positive test dose (p < 0.01). This suggests that the use of 1 mg.kg-1 lignocaine as a test dose would result in a significantly higher sensitivity for detecting intravascular injection than the use of 0.5 mg.kg-1.
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Br J Obstet Gynaecol · Mar 1995
Blood pressure changes during labour and whilst ambulating with combined spinal epidural analgesia.
To determine the influence of combined spinal epidural analgesia with fentanyl and low dose bupivacaine on maternal blood pressure and pulse rate in labour. Also, to evaluate the maternal cardiovascular response to mobilising with this form of analgesia in labour. Finally, to define the changes that occur in blood pressure and pulse rate during the second stage of labour and immediately postpartum when using combined spinal epidural analgesia. ⋯ The combined spinal epidural analgesia will only result in significant falls in systolic blood pressure within 30 minutes of the spinal injection. No further important changes in blood pressure occur when mobilising or with epidural top-ups. The combined spinal epidural analgesia may modify the normal compensatory mechanisms of blood pressure control, but does not cause significant maternal hypotension once the spinal injection has been given.
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Regional anesthesia · Mar 1995
Case ReportsUnintentional subdural block during labor epidural in a parturient with prior Harrington rod insertion for scoliosis. Case report.
The authors report a case of unintentional subdural block in a parturient with prior Harrington rod insertion. ⋯ Lumbar epidural anesthesia is not always an easily performed technique and is known to be associated with a higher incidence of complications in patients with prior Harrington rod insertion. Prompt recognition and proper management of subdurally placed needle and catheter avoided more serious complications.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialRopivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blind comparison.
We compared the effects of continuous epidural infusion of ropivacaine 0.25% with bupivacaine 0.25% on pain relief and motor block during labor, and on the neonate. Seventy-six full-term parturients in active labor requiring epidural analgesia were randomly allocated to receive either bupivacaine 0.25% or ropivacaine 0.25%. Fifteen minutes after a loading dose of 10 mL of the study drug, an epidural infusion with the same drug was started at 6-12 mL/h to maintain an adequate block. ⋯ There was a higher proportion of the neonates in the ropivacaine group (26/31 = 84%) who had a neurologic and adaptive capacity score (NACS) > or = 35 2 h after delivery than in the bupivacaine group (18/29 = 62%). We conclude that ropivacaine 0.25% and bupivacaine 0.25% are equally effective for epidural pain relief during labor. Ropivacaine may have an advantage over bupivacaine regarding neonatal neurobehavioral performance during the first few hours after delivery, although further studies will be required to substantiate this.