Continuous Extradural Analgesia: Comparison of Midwife Top-Ups, Continuous Infusions and Patient Controlled Administration

Purdie, J.; Reid, Jeremy; Thorburn, J.; Asbury, A. J.

doi:10.1093/bja/68.6.580

Cited by 69 publications

(32 citation statements)

References 6 publications

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“…PCEA produced similar levels of pain relief in most studies in terms of recorded Visual Analogue Scores for pain (135,137,140,(145)(146)(147)(148)(149)(150)(151)(152)(153)(154)(155). However, quality of pain relief is more than recorded VAS scores.…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Continuomentioning

confidence: 85%

“…Most studies also showed that local anaesthetic consumption is reduced with ITU (133,134,136,137). Despite less anaesthetic consumption, obstetric outcome is usually similar between the two modalities (135)(136)(137)(138)(139)(140), except for more spontaneous deliveries with ITU in the study by Smedstad et al (134). So basically, CEI and ITU are quite similar in terms of quality of analgesia and incidence of side-effects with a tendency towards better performance for the ITU technique.…”

Section: Intermittent Top-ups Versus Continuous Infusionmentioning

confidence: 96%

“…Also D'Athis et al showed that CEI is associated with better analgesia and less local anaesthetic consumption (133). However many studies reported no differences in terms of analgesic quality between ITU and CEI (133)(134)(135), and some reported that ITU was associated with better analgesia (136)(137). Most studies also showed that local anaesthetic consumption is reduced with ITU (133,134,136,137).…”

Section: Intermittent Top-ups Versus Continuous Infusionmentioning

confidence: 99%

“…Several studies compared PCEA with ITU techniques of maintaining epidural analgesia during labour (135,137,(140)(141)(142)(143)(144). Quality of pain relief was similar between the two modalities, except in the study by Paech et al (143): ITU resulted in higher maximal pain scores.…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

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Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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Section: Patient Controlled Epidural Analgesia (Pcea) Versus Continuomentioning

confidence: 85%

Section: Intermittent Top-ups Versus Continuous Infusionmentioning

confidence: 96%

Section: Intermittent Top-ups Versus Continuous Infusionmentioning

confidence: 99%

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

See 2 more Smart Citations

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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“…30,31 This technological advance significantly increases the satisfaction of labouring women particularly due to the sense of control while receiving epidural analgesia solutions. 32,33 The use of ropivacaine combined with the PCEA technique, at the University of Saskatchewan, provides the majority of labouring women the option to freely ambulate unassisted while receiving epidural analgesia. These changes now empower labouring women during one of life's most painful experiences with a sense of control and composure while retaining the physical strength and sensation necessary for childbirth.…”

mentioning

confidence: 99%