Choice of local anaesthetic for epidural caesarean section: a Bayesian network meta‐analysis

Reschke, Matthew; Monks, David T.; Varaday, S.; Ginosar, Yehuda; Palanisamy, Arvind; Singh, Preet Mohinder

doi:10.1111/anae.14966

Cited by 33 publications

(27 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The goal of the present prospective audit of practice was to evaluate the incidence of breakthrough pain anesthetics, usually a fast onset drug combined with a longer acting drug, increase the risk of breakthrough pain because they lose their potential when mixed together (the dose of the long acting local anesthetic is too low). These results are in line with previous reports 15,16 . All other potential factors that have been reported to be risk factors for breakthrough pain, were not confirmed in our cohort.…”

Section: Discussionsupporting

confidence: 94%

Breakthrough pain during cesarean section under neuraxial anesthesia: a two-center prospective audit

Roofthooft¹,

Lippens²,

Rex³

et al. 2022

Acta Anaest Belg

View full text Add to dashboard Cite

Worldwide, most Cesarean sections (CS) are performed under neuraxial anesthesia. However, neuraxial anesthesia can fail and intraoperative breakthrough pain can occur. The aim of the present investigation was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two center, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy. A total of 393 patients were enrolled in the study over 6 months, 206 in UZ Leuven and 187 in ZNA Middelheim, 295 elective CS and 98 secondary CS. Of all 393 participants, 65 experienced breakthrough pain during the CS (16.5%). Twoo significant risk factors for breakthrough pain during CS were observed: the duration of surgery (p <0.001) and the epidural drug used (p=0.0032). Breakthrough pain during a CS is extremely uncomfortable for the mother. In this observational study, the incidence of breakthrough pain during CS was 16.5%. Duration of surgery and epidural drug used were both significant risk factors of breakthrough pain during CS in this audit. A pro-active policy is required in order to prevent breakthrough pain or discomfort during CS. Early identification of problematic epidural catheters for labor analgesia, adequate level of anesthetic block before surgery, and administration of a prophylactic epidural top-up if duration of surgery is prolonged as opposed to the choice of local anesthetic used, could be essential in the prevention. Further high-quality studies are needed to evaluate the many potential risk factors associated with breakthrough pain during CS.

show abstract

Section: Discussionsupporting

confidence: 94%

Breakthrough pain during cesarean section under neuraxial anesthesia: a two-center prospective audit

Roofthooft¹,

Lippens²,

Rex³

et al. 2022

Acta Anaest Belg

View full text Add to dashboard Cite

show abstract

“…9,23 A recent Bayesian network meta-analysis including 24 randomized clinical trials reported the rank order of EA onset for cesarean section with 2% lidocaine plus bicarbonate as the fastest, followed by 3% 2-chloroprocaine and 2% lidocaine. 24 Ituk et al found that the onset times of 2% lidocaine with epinephrine and 3% chloroprocaine were 10-12 min and 3-5 min, respectively, when extending labor analgesia to anesthesia. 9 Few direct comparisons of the onset time of lidocaine and chloroprocaine in labor EA are available.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

Zhu

Wang

et al. 2022

IJGM

View full text Add to dashboard Cite

This study aimed to explore the efficacy and safety of chloroprocaine for activating labor analgesia and the optimal concentration compared to lidocaine. Patients and Methods: Ninety-six nulliparous parturients were randomly assigned to three groups: LD group, patients received the conventional initial dose of 6 mL of 1% lidocaine; CP1.5 group, patients received 6 mL of 1.5% chloroprocaine as the initial dose; and CP1.2 group, patients received 7.5 mL of 1.2% chloroprocaine as initial dose. Labor analgesia was maintained in all patients via a programmed intermittent epidural bolus (PIEB). The primary outcome was the analgesia onset time. Secondary outcomes included the visual analog scale (VAS) scores, the interval and duration of uterine contractions during the first 12 contractions, failure to reach adequate analgesia, labor and neonatal outcomes, maternal satisfaction and adverse effects. Results: Parturients in the CP1.5 and CP1.2 groups achieved a shorter onset time than those in the LD group (hazard ratio (HR) = 6.540; 95% confidence interval (CI), 3.503-12.210; P < 0.001 and HR = 3.460; 95% CI, 1.905-6.282; P < 0.001, respectively). The median time (95% CIs) to adequate analgesia was 12.

show abstract

“…Previous studies showed that the incidences of hypotension in parturients who underwent a cesarean section were 32–52% after EA, 43–64% after SA, and 32–70% after CES ( 8 – 11 , 20 – 22 , 26 ). In present study, the incidences of hypotension after neuraxial anesthesia were ~58 and 40% in parturients with and without COVID-19, respectively.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Neuraxial Anesthesia-Related Hypotension in COVID-19 Parturients Undergoing Cesarean Delivery: A Multicenter, Retrospective, Propensity Score Matched Cohort Study

et al. 2021

View full text Add to dashboard Cite

Background: SARS-CoV-2 infection was referred to sympathetic hyperactivity, which might increase the susceptibility of neuraxial anesthesia-related hypotension resulted from sympathetic inhibition. We conducted a multicenter, retrospective, propensity score matched (PSM) cohort study to determine whether COVID-19 parturients have an increased risk of hypotension after neuraxial anesthesia for cesarean delivery.Methods: Clinical data of COVID-19 parturients were collected from the electronic medical records from 1th January to 31th May, 2020 in three hospitals of Hubei Province, China. Information of Control parturients (without COVID-19) were obtained at the same institutions over a similar period in 2019. All American Society of Anaesthesiologists (ASA) Physical Status II full termed pregnant women who received cesarean delivery under neuraxial anesthesia were included. The primary objective was to obtain and compare the incidence of neuraxial anesthesia-related hypotension. Secondary objectives were the analysis of anesthetic implementation and administration, intraoperative maternal vital signs and adverse reactions, and neonatal Apgar scores at 1 and 5 min after delivery. The clinical characteristics of COVID-19 parturients were also analyzed. PSM was derived to balance the predictors for neuraxial anesthesia-related hypotension based on previous studies.Results: In present study, 101 COVID-19 parturients and 186 Control parturients were derived from 1,403 cases referenced to propensity score matching. The incidence of neuraxial anesthesia-related hypotension was 57.4% in COVID-19 parturients and 41.9% in Control parturients with an incidence risk ratio (IRR) of 1.37 (95% CI 1.08–1.74; P = 0.012; post-hoc Cramér's V = 0.15) in the PSM cohort. The incidences of nausea, vomiting, dizziness, and shaking were significantly higher in the COVID-19 group than Control group (48.5 vs. 17.2%, P < 0.001; 10.9 vs. 4.3%, P = 0.03; 18.8 vs. 3.2%, P < 0.001; 51.5 vs. 18.3%, P < 0.001; respectively). The Apgar scores at 1 min was significantly lower in newborns from COVID-19 parturients than that in Control babies (P = 0.04).Conclusions: An increased risk of neuraxial anesthesia-related hypotension in COVID-19 parturients undergoing cesarean delivery should be stressed.

show abstract

Choice of local anaesthetic for epidural caesarean section: a Bayesian network meta‐analysis

Cited by 33 publications

References 41 publications

Breakthrough pain during cesarean section under neuraxial anesthesia: a two-center prospective audit

Breakthrough pain during cesarean section under neuraxial anesthesia: a two-center prospective audit

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

The Risk of Neuraxial Anesthesia-Related Hypotension in COVID-19 Parturients Undergoing Cesarean Delivery: A Multicenter, Retrospective, Propensity Score Matched Cohort Study

Contact Info

Product

Resources

About