Articles: analgesia.
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Letter Case Reports
A simple solution to blood clot obstruction of epidural catheter during labour.
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Anesthesia and analgesia · Jan 1990
Impaired epidural analgesia after dural puncture with and without subsequent blood patch.
We carried out a retrospective assessment of epidural analgesia in 46 parturients who had a previous dural puncture. Of 29 women who had both dural puncture and blood patch previously, only 59% had an uncomplicated successful second epidural anesthetic. Of 17 parturients who had dural puncture but no blood patch previously, only 65% had an uncomplicated successful subsequent epidural anesthetic. ⋯ The data suggest that dural puncture may lead to impaired epidural analgesia subsequently. Epidural blood patch after dural puncture did not lead to any further decrease in the rate of good analgesia with subsequent epidural anesthetics. Parturients who request epidural analgesia and who have had previous dural puncture with or without blood patch should be informed about the 35%-40% chance of poor epidural analgesia.
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Postoperative analgesia remains frequently insufficient in children. This is in part due to the difficult assessment of pain in the different age groups. ⋯ The different analgesic drugs and techniques available allow to establish guidelines for postoperative analgesia in different age groups of children, under different surgical and postoperative conditions. On the basis of such guidelines, ordered analgesics have a greater chance to be really administered at the proper time to each child.
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Acta Obstet Gynecol Scand · Jan 1990
The effect of delayed pushing in the second stage of labor with continuous lumbar epidural analgesia.
We studied primigravid women in spontaneous labor at term and given epidural analgesia. Two hundred such women giving birth in 1983 were compared with similar groups who gave birth in 1985 and 1987 after the introduction of 'delayed pushing' into our labor ward protocol. Four hundred controls were obtained in 1983 and 1985 by selecting from the labor ward register the next normal primigravid woman in spontaneous labor without epidural analgesia. ⋯ Among epidural labors, there was no significant difference between 1983 and 1987 in the incidence of rotational or non-rotational forceps, or of cesarean section. In each epidural group, women who waited more than 60 min were less likely to experience a normal spontaneous delivery than were those who did not (p less than 0.001 in 1983; p = 0.006 in 1985 p = 0.035 in 1987). We conclude that to delay pushing beyond 60 min confers no benefit regarding mode of delivery.