Articles: analgesia.
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Int J Obstet Anesth · Jul 1994
The association between foot temperature and asymmetrical epidural blockade.
This study was designed to explore the correlation between sensory block asymmetry and a disparity in foot temperature following epidural bupivacaine administration in labour. Sixty parturients requesting epidural analgesia had epidural catheters sited at L 3/4 while in the lateral position. A test dose was followed 5 min later by a main dose of 25-30 mg of plain bupivacaine. ⋯ Most staff were able to detect a foot temperature difference > 1 degrees C. Our findings indicate a clear association between sensory block asymmetry and the difference between the temperature of the feet. This difference can be detected simply by feeling the feet.
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Acta Obstet Gynecol Scand · Jul 1994
Randomized Controlled Trial Clinical Trial'To bathe or not to bathe' during the first stage of labor.
Does a warm tub bath relieve labor pain? How is it experienced by the parturient? ⋯ Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended.
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Anesthesia and analgesia · Jul 1994
Postoperative epidural analgesia and oral anticoagulant therapy.
The relative safety of epidural catheter placement with subsequent heparinization has been well documented. However, what is the risk of neurologic sequelae in such patients who receive warfarin perioperatively? This study retrospectively evaluates the risk of spinal hematoma in patients receiving postoperative epidural analgesia while receiving low-dose warfarin after total knee replacement. All patients received low-dose warfarin to prolong the prothrombin time (PT) to 15.0-17.3 s (normal 10.9-12.8 s). ⋯ Mean PT at the time of epidural catheter removal was 13.4 +/- 2 s. There were no signs of spinal hematoma. Although epidural catheter placement and subsequent anticoagulation with warfarin appears relatively safe, there is a large variability in patient response to warfarin; therefore, coagulation status should be monitored to avoid excessive prolongation of the PT, and the patient should be watched closely for evidence of spinal hematoma.
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Int J Obstet Anesth · Jul 1994
The incidence of herpes simplex virus labialis after cesarean delivery.
Epidural and subarachnoid opioids have been associated with the development of oral herpes simplex lesions. Because of this risk, some anesthesiologists avoid neuraxial morphine in parturients with a history of herpes simplex virus labialis. When we began using neuraxial opioids for analgesia after cesarean delivery, we did not see any increased incidence of facial lesions. ⋯ Neuraxial morphine did not increase the risk of labial lesions significantly (3.5% vs. 2.6%). Despite published data to the contrary, we found no correlation between neuraxial morphine and the risk of facial herpes virus lesions in women after cesarean delivery. We offer patients the option of neuraxial morphine for analgesia after cesarean delivery despite any history of oral herpes lesions.
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J Pain Symptom Manage · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialEffect of clonidine on postpartum shivering after epidural analgesia: a randomized, controlled, double-blind study.
In obstetric patients treated with epidural analgesia during labor and delivery, shivering is quite frequent due to stress, vasodilatation, infusion of fluids, low ambient temperature, and the direct effect of solution injected into the epidural space. Sixty obstetric patients who developed shivering after receiving epidural analgesia for delivery were randomly assigned to treatment with clonidine 0.150 mg i.v. (N = 20), meperidine 50 mg i.v. (N = 20), or saline solution (N = 20). Drug administration was double blind. ⋯ Clonidine was as effective as meperidine in controlling shivering and caused a greater reduction in heart rate. Drowsiness occurred after clonidine as well as meperidine. Thus, clonidine proved to be effective in controlling shivering and adrenergic response after delivery using epidural analgesia and produced an acceptable level of drowsiness.