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Created May 21, 2015, last updated 15 days ago.
Collection: 6, Score: 2321, Trend score: 0, Read count: 2672, Articles count: 15, Created: 2015-05-21 02:07:40 UTC. Updated: 2024-11-08 10:00:07 UTC.Notes
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Collected Articles
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Randomized Controlled Trial Comparative Study
A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor.
Fentanyl-only epidural infusion shows no benefit over fentanyl/bupiv in respect to duration of labor, motor block, delivery, analgesia, or outcomes.
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Anesthesia and analgesia · Jan 2013
Review Meta Analysis Comparative StudyIntermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis.
Intermittent epidural bolus when compared with continuous epidural infusion for labour analgesia results in slightly reduced local anaesthetic use and a small improvement in maternal satisfaction. Caesarean section and instrumental delivery rates were not significantly statistically different.
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Lidocaine with epinephrine is the most optimal solution for epidural top-up for emergency caesarean section. Adding fentanyl further speeds onset.
pearl -
Int J Obstet Anesth · Oct 2012
Review Meta AnalysisRisk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.
Multiple labour epidural top-up boluses, caesarean section urgency or care by non-obstetric anaesthetists increase risk of failed epi anaesthesia.
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Int J Obstet Anesth · Oct 2010
Randomized Controlled TrialUltrasound decreases the failed labor epidural rate in resident trainees.
Epidural analgesia is widely used for pain relief during labor. The purpose of this study was to determine if ultrasound measurement of the depth from skin to epidural space before the epidural technique decreases the failure rate of labor analgesia. A secondary objective was to correlate ultrasound depth to the epidural space with actual depth of the needle at placement. ⋯ Ultrasound measurement of the epidural space depth before epidural technique placement decreases the rate of epidural catheter replacements for failed labor analgesia, and reduces the number of epidural attempts when performed by first year residents and compared to attempts without ultrasound guidance.
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Int J Obstet Anesth · Apr 2011
Randomized Controlled Trial Comparative StudyA randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.
The μ-opioid agonist remifentanil has a rapid onset and offset and a short half-life making it an attractive option for intravenous patient-controlled labour analgesia. We aimed to compare the efficacy of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. ⋯ In the 20 patients recruited to this study, pain relief in labour with epidural ropivacaine/sufentanil was more effective than with intravenous remifentanil patient-controlled analgesia.
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Int J Obstet Anesth · Jan 2012
Randomized Controlled Trial Comparative StudyA prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
After accidental dural puncture in labour it is suggested that inserting an intrathecal catheter and converting to spinal analgesia reduces postdural puncture headache and epidural blood patch rates. This treatment has never been tested in a controlled manner. ⋯ Converting to spinal analgesia after accidental dural puncture did not reduce the incidence of headache or blood patch, but was associated with easier establishment of neuraxial analgesia for labour. The most significant factor increasing headache and blood patch rates was the use of a 16-gauge compared to an 18-gauge epidural needle.
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Int J Obstet Anesth · Oct 2010
Randomized Controlled Trial Comparative StudyA randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery.
Automated mandatory boluses (AMB), when used in place of a continuous basal infusion, have been shown to reduce overall local anesthetic consumption without compromising analgesic efficacy in patient-controlled epidural analgesia (PCEA). We hypothesized that our PCEA+AMB regimen could result in a reduction of breakthrough pain requiring epidural supplementation in comparison with PCEA with a basal infusion (PCEA+BI). ⋯ PCEA+AMB, when compared to PCEA+BI, confers greater patient satisfaction and a longer duration of effective analgesia after CSE despite reduced analgesic consumption.
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Randomized Controlled Trial Clinical Trial
A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour.
It has recently been suggested that systemic pethidine is ineffective in relieving labour pain. This study aims to evaluate the analgesic efficacy of pethidine in labour. ⋯ Systemic pethidine was more effective at relieving labour pain than placebo. Its analgesic effect, however, was modest.
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Cochrane Db Syst Rev · Oct 2014
Review Meta AnalysisEarly versus late initiation of epidural analgesia for labour.
High level evidence does not show any clinically meaningful difference for early vs late labour epidural analgesia, whether on maternal or neonatal outcomes.
pearl -
Randomized Controlled Trial Multicenter Study Comparative Study
Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial.
To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. ⋯ In women in labour, patient controlled analgesia with remifentanil is not equivalent to epidural analgesia with respect to scores on satisfaction with pain relief. Satisfaction with pain relief was significantly higher in women who were allocated to and received epidural analgesia.
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Neuraxial labour analgesia for vaginal delivery is associated with a significant reduction in the risk of severe maternal morbidity.
pearl -
Labour epidural analgesia is associated with a 35% reduction in severe maternal morbidity, and even greater in those preterm or with medical comorbidity.
pearl -
Review Practice Guideline
Intrathecal catheter placement after inadvertent dural puncture in the obstetric population: management for labour and operative delivery. Guidelines from the Obstetric Anaesthetists' Association.
Recommendations:
- An intrathecal catheter may be inserted for the provision of analgesia and anaesthesia following inadvertent dural puncture during attempted epidural catheter placement. This decision must be made with consideration of potential risks and benefits (Grade C, moderate level of certainty).
- Whether using intermittent boluses or a continuous infusion technique, use the same local anaesthetic solution throughout labour (Grade I, low level of certainty).
- Maternal blood pressure should be checked every 5 min for 15 min following the first dose, and after every subsequent bolus given via an intrathecal catheter (Grade A, high level of certainty).
- As with epidural analgesia, sensory and motor block should be checked every hour during intrathecal catheter analgesia (Grade B, moderate level of certainty).
- Fetal heart rate should be continuously monitored during intrathecal analgesia (Grade B, moderate level of certainty).
- Top-ups of local anaesthetic for caesarean delivery should be given incrementally, with each bolus limited to 2.5 mg bupivacaine (or equivalent) (Grade I, low level of certainty).
- Extension of labour analgesia for caesarean delivery via an intrathecal catheter should be performed in an operating theatre (Grade B, moderate level of certainty).
- Non-invasive blood pressure, ECG and oxygen saturations should be monitored throughout the duration of intrathecal anaesthesia (Grade A, high level of certainty).
- All departments should have clear guidelines for the management of intrathecal catheters in labour and for delivery. These should highlight key risks, monitoring protocols and other safety measures (Grade A, low level of certainty).
- Only anaesthetists should administer top-ups through an intrathecal catheter, and connect, disconnect or reconnect the catheter and tubing (Grade A, low level of certainty).
- Anaesthetists should account for the dead space of the intrathecal catheter and filter when administering top-ups in labour or for operative delivery (Grade B, low level of certainty).
- An intrathecal catheter should be clearly labelled adjacent to the filter and on the front of any infusion pump (Grade A, low level of certainty).
- The multidisciplinary team (including any non-resident staff who may be called to attend the patient during labour or delivery), must be made aware of the intrathecal catheter through both verbal and written communication, including at every handover (Grade A, low level of certainty).
- Intrathecal catheters should be removed at the earliest opportunity following delivery to reduce the risk of accidental overdose and infectious complications (Grade B, low level of certainty).
- When patients who experience inadvertent dural puncture, with or without intrathecal catheter insertion, are discharged from hospital, follow-up should be in line with established guidance and include written information on headaches, ‘red flag’ symptoms, hospital contact information and communication with primary care (Grade B, low level of certainty).
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Daniel Jolley