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  Does epidural labour analgesia reduce the risk of postpartum depression?

  Analgesia Epidural Obstetric anesthesia

   
  • Observational Study

    Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study.

    Anesth. Analg.. 2014 Aug 1;119(2):383-92.

    Labour epidural analgesia may be associated with a lower incidence of post-natal depression.

    pearl

  • Observational Study

    The Relationship Between Women's Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study.

    Anesth. Analg. 2018 May 1; 126 (5): 1590-1597.

    Intending to deliver with labour epidural analgesia and then receiving a labour epidural is associated with slightly lower rate of postnatal depression.

    pearl

  • Observational Study

    Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study.

    Anesth. Analg. 2018 May 1; 126 (5): 159816051598-1605.

    A greater relief in labor pain with epidural analgesia is associated with lower postpartum depression scores, although with less clinical significance than other risk factors.

    pearl

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  Ketamine infusions

  Analgesia Ketamine Pain

   
  • Randomized Controlled Trial

    Absence of long-term analgesic effect from a short-term S-ketamine infusion on fibromyalgia pain: a randomized, prospective, double blind, active placebo-controlled trial.

    Eur J Pain. 2011 Oct 1;15(9):942-9.

  • Case Reports

    Drug-induced liver injury following a repeated course of ketamine treatment for chronic pain in CRPS type 1 patients: a report of 3 cases.

    Pain. 2011 Sep 1;152(9):2173-8.

  • Randomized Controlled Trial

    Pain relief is associated with improvement in motor function in complex regional pain syndrome type 1: secondary analysis of a placebo-controlled study on the effects of ketamine.

    J Pain. 2013 Nov 1;14(11):1514-21.

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  Lignocaine

  Lidocaine Local anesthetics

   
  • Randomized Controlled Trial

    Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.

    Anesth. Analg.. 2012 Aug 1;115(2):262-7.

    Intraoperative intravenous lidocaine improves the quality of recovery following ambulatory laparoscopic surgery.

    pearl

  • Randomized Controlled Trial

    Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.

    Clin J Pain. 2012 Sep 1;28(7):567-72.

  • Randomized Controlled Trial

    Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery.

    Anesthesiology. 2013 Oct 1;119(4):932-40.

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  Chronic pain

  Pain

   
  • Randomized Controlled Trial

    The Subjective Psychoactive Effects of Oral Dronabinol Studied in a Randomized, Controlled Crossover Clinical Trial For Pain.

    Clin J Pain. 2014 Jun 1; 30 (6): 472-8.

    The oral cannabinoid dronabinol has similar psychoactive effects to smoking marijuana.

    pearl

  • Review

    Long- or short-acting opioids for chronic non-malignant pain? A qualitative systematic review.

    Acta Anaesthesiol Scand. 2014 Apr 1; 58 (4): 390401390-401.

  • Controlled Clinical Trial

    Analgesic and anti-hyperalgesic effects of muscle injections with lidocaine or saline in patients with fibromyalgia syndrome.

    Eur J Pain. 2014 Jul 1; 18 (6): 803-12.

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  Etomidate

  Drugs Etomidate Intravenous anesthetics

   

  Etomidate (Amidate™) is short-acting intravenous anesthetic agent first developed in 1964. It is available and used in the United Kingdom, Europe, New Zealand, United States, but not Australia.

  Advocates highlight etomidate's hemodynamic stability when used for induction. Critics point to the well-established adrenocortical suppression, and wide-range of suitable alternatives (propofol, ketamine, thiopentone) in trained hands.

  A. Physiochemistry

  • Carboxylated imidazole
  • 2 isomers - only R(+) hypnotic
  • Haemodynamic stability, minimal respiratory depression, cerebral protection, wide margin of safety.
  • Originally formulated in propylene glycol (painful), now in soybean lipid.

  B. Pharmacokinetics

  1. Dose - 0.3 mg/kg (0.1-0.4 mg/kg)
  2. Absorption - IV
  3. Distribution - 4 L/kg
  4. Protein binding - 75% (like thiopentone)
  5. Onset 30-60s ; Offset
  6. Metabolism - alpha1 ½ 2.5m, alpha2 ½ 30m, tß½ 3.5h; hepatic ester hydrolysis of ester side chain.
  7. Clearance - 20 mL/kg/min

  C. Pharmacodynamics

  1. Mech - probably by GABAa receptors.
  2. CNS - hypnosis; no analgesic action; ⇣ CBF and CMRO2
  3. CVS - stable; may have slight dec MAP 15% due to ⇣ SVR.
  4. Resp - minimal; sometimes brief hypoventilation or apnoea post-induction.
  5. Endo - adrenocortical suppression - inhibits 11ß-hydroxylase (11-deoxycortisol → cortisol). Temporary & reversed by vit C.
     • ⇡ ICU mortality when used for sedation.
  6. SEs - excitatory phenom, involuntary muscle movement (50%), PONV (30%), thrombophlebitis (20%), pain on injection.

  reference

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  • Article

    The use of etomidate for prehospital rapid-sequence intubation.

    Prehosp Emerg Care. 2003 Jul 1; 7 (3): 380-3.

  • Randomized Controlled Trial

    Etomidate versus thiopental for induction of anesthesia.

    Anesth. Analg. 1985 Sep 1;64(9):871-6.

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