Articles: analgesia.
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Rev Esp Anestesiol Reanim · Jul 1994
Clinical Trial[Obstetric analgesia using continuous epidural perfusion of bupivacaine, adrenaline, and fentanyl].
To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth. ⋯ Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.
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The combined spinal-epidural technique is a modification of epidural analgesia which combines the rapid onset of spinal analgesia with the flexibility of an epidural catheter. We sought to evaluate the effectiveness of an intrathecal opioid--low-dose local anaesthetic combination for parturients in advanced labour, a setting where satisfactory epidural analgesia is often difficult to achieve. The technique was evaluated in an open-label, non-randomized trial using parturients in advanced, active labour for the provision of pain relief during the late first stage and second stage of labour. ⋯ Onset of analgesia was rapid (< five minutes) in all cases. Twenty-three patients (60%) delivered vaginally with no additional anaesthetic. The remaining 15 had supplemental local anaesthetic given via the epidural catheter, a mean of 123 +/- 33 min after the original spinal dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Failures of lumbar epidural analgesia caused by transforaminal passage of an epidural catheter in two cases].
In one case, analgesia level obtained with a 20 ml of 1.5% mepivacaine was unilateral and inadequate. In the other case, an epidural catheter was inserted after a 20 ml of 2% mepivacaine was injected through a Tuohy needle. ⋯ If an epidural catheter is advanced beyond 5 cm into the epidural space, it may migrate outwards through the intervertebral foramen. Therefore, the insertion of an epidural catheter should be limited to 3-4 cm.
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Comparative Study
[Comparison of continuous extradural analgesia during labor using 0.25% bupivacaine or mixtures of 0.25% bupivacaine and fentanyl].
We have compared effects of epidural analgesia in labour in two groups containing 35 primiparous each and in two groups containing 35 multiparous each. We have administered either bupivacaine or bupivacaine with fentanyl. ⋯ This investigation has shown that use of 0.25% bupivacaine with fentanyl requires less quantity of bupivacaine in both groups of primiparous and multiparous. The addition of fentanyl to 0.25% bupivacaine can be beneficial alternative of epidural analgesia in labour.