Combined Spinal–Epidural versus  Epidural Labor Analgesia

Norris, Mark C.; Fogel, Steven T.; Conway-Long, C.

doi:10.1097/00000542-200110000-00020

Cited by 116 publications

(69 citation statements)

References 17 publications

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“…The indications in four of them were for uterine dystocia and the other four for non-reassuring foetal condition. A caesarian rate of 12.5% in our study is comparable with that by Norris and Fogel of 13.4% (149/ 1112 patients) [11] with similar indications in the two studies. Newton and colleagues compared myometral activity in those receiving bupivacaine/fentanyl epidural infusions with non-randomised controls receiving pethidine and reported no difference, although need for oxytocin was greater and the rate of cervical dilatation slower in the epidural group [12].…”

Section: Discussionsupporting

confidence: 91%

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

K¹,

Puri²,

Goel

2006

Medical Journal Armed Forces India

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Original Article IntroductionT he control of pain should forms an integral part of the management of labour, yet pain relief in labour is a controversial subject. Pregnant woman have a right to basic information about pain and its relief in labour. Labour analgesia, is rapidly catching up in the Armed Forces, and it would still be a while, before all women in labour are offered this service. Amongst the various modalities of pain relief in labour, epidurals have gained popularity. The aim of this study was to compare a relatively less utilised opioid, butorphanol with the timetested fentanyl in epidural labour analgesia. MethodThe study was approved by our hospital ethics committee and informed consent was obtained from each patient. 64 women with American Society of Anaesthesiologists physical status I and II, between the ages of 18 and 40 years who opted for epidural labour analgesia were enrolled. Participants had singleton pregnancy of greater than 36 weeks of gestation with vertex presentation. All women were in active labour with cervical dilatation of 3 to 5 cm at the time of epidural catheter placement. The women had a pre dose Visual Analog Score (VAS) for labour pain of ≥ 30mm measured on two occasions, when two consecutive uterine contractions occurred.Patients with known hypersensitivity to local anaesthetics, neurologic, neuromuscular or psychiatric disorders, blood dyscrasias, weight greater than 110 kg, height less than 144 cm, cephalopelvic disproportion, known foetal abnormalities or multiple pregnancy were excluded from the study.Randomisation was done by the toss of a coin and patients were allocated to two groups. The first group (n=32) received 15ml of 0.1% bupivacaine with 0.1mgml -1 butorphanol (1.5mg) and the second group (n=32) received 15ml of 0.1% bupivacaine with 2μgml -1 of fentanyl. The patient and anaesthesiologist were blind to the drug combination, which was prepared by a trained assistant.All patients were started on an intravenous infusion of ringer lactate. An 18 gauge epidural catheter was placed 3 to 4 cm inside the epidural space via an 18-gauge Tuohy epidural needle at the L2-3 or L3-4 level. If there was any evidence of entry into an epidural vein or cerebrospinal fluid the patient was excluded from the study. After negative aspiration, a bolus of 15 ml of either drug was given over 5 minutes. A test dose was omitted.The efficacy of the drug was assessed using a 100 mm visual analogue scale, where 0 represented no labour pain and 100 represented the worst possible pain, at five minute intervals and during contractions for the first 20 min, at 20 minute intervals for the first hour, at 30 minute intervals for the next hour, and hourly thereafter, till the end of labour or when patient complained of pain. -1 of fentanyl. Results: The times of onset and offset of analgesia were comparable. More patients of the butorphanol group were sedated but arousable. The patient satisfaction levels were good in both groups and APGAR scores were comparable. Conclusion: Butorphanol and fe...

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Section: Discussionsupporting

confidence: 91%

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

K¹,

Puri²,

Goel

2006

Medical Journal Armed Forces India

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“…These problems are reflected in the resite rate which depends on the actual method and the equipment. A very low failure rate of 0.5-0.8% was reported by Norris et al (2001) in a randomised prospective study including 2183 parturients receiving either CSE or EDA, with no difference between the two methods. In another setting, in a large retrospective study including 3233 vaginal deliveries the epidural replacement rate was 12.1% (Eappen et al 1998).…”

Section: Analgesia With Remifentanil Epidural Block and Nitrous Oxidementioning

confidence: 86%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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“…D'Angelo e col. 17 afirmaram que o uso do sufentanil não está associado à hipertonia uterina, e que a bradicardia fetal observada deve ser devida à hipotensão arterial materna após o BC. No estudo realizado, a prevalência de bradicardia fetal persistente, levando à indicação de cesariana como via de parto, foi de 2,9%, variando na literatura de 5% a 8% 18 . Porém, não se observou relação com o uso do sufentanil, sendo que um número menor de pacientes no grupo SUF (2,6%) apresentou bradicardia comparativamente ao grupo AL (3,3%).…”

Section: Discussionunclassified

“…3 encontraram evolução mais rápida do trabalho de parto no grupo do BC, resultado este não confirmado por Norris e col. 18 . Não houve diferença entre as técnicas utilizadas para realização do BC com relação às complicações observadas.…”

Section: Discussionunclassified

Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

Cicarelli¹,

Silva²,

Frerichs³

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:O bloqueio combinado (BC) é uma técnica muito utilizada em anestesia obstétrica. Porém não há na literatura padronização com relação à técnica, doses e anestésicos utilizados, além da controvérsia sobre a possibilidade da adição do opióide ao anestésico local causar bradicardia fetal e alteração de sua vitalidade. O objetivo deste estudo foi identificar as técnicas e anestésicos utilizados no Serviço de Anestesiologia do Hospital Universitário da Universidade de São Paulo (USP) e avaliar se a utilização de sufentanil associado ao anestésico local no BC altera o Apgar dos recém-nascidos. MÉTODO:Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitário da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5°e10° minutos dos recém-nascidos. RESULTADOS:Dos 635 BC avaliados, 307 utilizaram sufentanil e anestésico local (Grupo SUF) e 328, só anestésico local (Grupo AL). Cento e vinte e sete (20%) foram realizados através da técni-ca de agulha por dentro de agulha e os outros 508 (80%) foram realizados pela técnica de duas punções. Não foi verificada diferença entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSÕES: O sufentanil utilizado no bloqueio combinado não alterou o Apgar dos recém-nascidos.Unitermos: ANALGESIA, Obstétrica: parto; ANALGÉSICOS, Opióide: sufentanil; AVALIAÇÃO RECÉM-NASCIDO: Apgar; TÉCNICAS ANES-TÉSICAS, Regional: combinada. SUMMARYCicarelli DD, Silva RV, Frerichs E, Pagnocca ML -Combined SpinalEpidural for Labor Analgesia: Does the Addition of Sufentanil to the Local Anesthetic Influence Apgar Scores of the Newborns? BACKGROUND AND OBJECTIVES:Combined spinal-epidural (CSE) is a very common obstetric technique. However, the literature does not present a standardization regarding the technique, doses, and anesthetics used, besides there is also the controversy about the possibility that the addition of opioids to the local anesthetic causes fetal bradycardia and affects its vitality. The aim of this study was to identify the techniques and anesthetics used in the Anesthesiology Service of the Hospital Universitário of Universidade de São Paulo (USP) and determine whether the use of sufentanil associated with the local anesthetic affects Apgar scores of newborns. METHODS:The anesthesiology charts of patients submitted to CSE for labor analgesia over a 12-month period at the Hospital Universitário of USP were analyzed. The use and dose of sufentanil, the type of delivery, and Apgar scores in the 1 st , 5 th , and 10 th minutes were recorded. RESULTS:Of the 635 CSE analyzed, 307 used sufentanil and local anesthetic (SUF Group) and 328 only local anesthetic (LA Group). One hundred and twenty-seven (20%) were done using the needle through the needle technique and the other 508 (80%) used the double puncture technique. There were no differences in the Apgar scores in the 1 st , 5 th , and 10 th minutes between both groups. CONCLUSIONS:T...

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Combined Spinal–Epidural versus Epidural Labor Analgesia

Cited by 116 publications

References 17 publications

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

Intravenous patient-controlled analgesia with remifentanil in early labour

Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos?

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