The use of the combined spinal epidural (CSE) technique facilitates the initiation of analgesia by an intrathecal dose of sufentanil or fentanyl and has gained widespread acceptance because of the rapid onset of analgesia achieved without any motor blockade. 1 Several studies have reported the analgesic properties of spinal sufentanil and fentanyl for labour analgesia, including their potency ratio, length of the analgesia and side effects. [2][3][4][5][6][7][8][9] Occasionally, however, it may be difficult to place a spinal anaesthetic (eg anatomy of the lower back, obesity or irritated skin in the area) but an epidural can be sited two to three interspaces cranially. 10-12 Alternatively, patient characteristics such as elevated intracranial pressure or history of post-dural puncture headache may support using epidural rather than spinal approach for labour analgesia. 13 Therefore, we wanted to compare spinal/CSE and epidural sufentanil and fentanyl for their efficacy against contraction pain in early labour. The primary endpoint was pain relief at 20 minutes after the neuraxial opioid dose and the secondary endpoints were the speed of onset of analgesia and the time to the first request for additional epidural analgesia. | ME THODSThe study was registered at ClinicalTrials.gov (NCT02885350). After approval of the Ethics Committee of Helsinki University Hospital and a written, informed consent from each subject, 80 nulliparous women undergoing vaginal delivery were studied. Women requiring pain relief with reassuring foetal cardiotocograph (CTG) tracings

Aim To examine how physical ability and comorbidity associate with oral health. Methods and results The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self‐perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self‐perceived oral discomfort (PRR: 1.74, CI: 1.01‐3.03; PRR: 1.20, CI: 1.06‐1.35; PRR: 1.20, CI: 1.05‐1.36, respectively). Furthermore, IADL associated also with poor self‐perceived oral health (PRR: 1.27, CI: 1.03‐1.57). Conclusion Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self‐perceived oral health.