Determination of the ED95 for intrathecal plain bupivacaine combined with fentanyl in active labor

Whitty, R.; Goldszmidt, Eric; Parkes, Robert; Carvalho, Jose C. A.

doi:10.1016/j.ijoa.2007.06.004

Cited by 16 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 UDM can be used to determine other quantiles using methods such as the biased coin design 11 or the Narayana rule, 12 but these have not been described commonly in the anesthetic literature. 13 Results from UDM studies can be easily and simply displayed graphically. However, UDM has a number of important limitations.…”

Section: Discussionmentioning

confidence: 99%

Determination and Comparison of Graded Dose–Response Curves for Epidural Bupivacaine and Ropivacaine for Analgesia in Laboring Nulliparous Women

Kee

Ng²,

Khaw

et al. 2010

Anesthesiology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Determination and Comparison of Graded Dose–Response Curves for Epidural Bupivacaine and Ropivacaine for Analgesia in Laboring Nulliparous Women

Kee

Ng²,

Khaw

et al. 2010

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…determined that the ED 95 of intrathecal bupivacaine with fentanyl 15 μg was 1.66 mg (95% CI 1.50–482.5 mg). The high upper range of 95% CI was acknowledged by the authors as a statistical anomaly but concluded that the success rate of sensory block was 100% in patients who received 1.75 mg [30]. Van de Velde et al.…”

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

“…At a dose of bupivacaine 1.75 mg or less, with fentanyl 15 μg, no patient evaluated by Whitty et al. presented with motor blockade [30]. These results suggest that when intrathecally administered, bupivacaine may have greater motor blockade potency than levobupivacaine and ropivacaine; but at clinical doses for labour analgesia, the incidence of motor block is low and should not be of concern to the clinician.…”

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

“…[21] and used in other prospective trials [16, 29], consists of bupivacaine 2.5 mg with fentanyl 25 μg. The effective dose in 95% of the population (ED 95 ) is a more valuable approximation of a clinical dose and can be estimated from an up‐down sequential allocation model, albeit with some degree of error [30]. Sia et al.…”

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

View full text Add to dashboard Cite

SummarySeveral strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is rapidly evolving, this review is an update, from a clinical point of view, of developments over the last 5-7 years. We discuss advantages and controversies related to combined spinal-epidural analgesia, patient controlled epidural analgesia and the integration of computer systems into analgesic modalities. We also review the recent literature on future clinical and research perspectives including ultrasound guided neuraxial block placement, epidural adjuvants and pharmacogenetics. We finally look at the latest work with regards to epidural analgesia and breastfeeding. Several strategies and alternative therapies have been used to provide analgesia for one of women's most painful experiences in life, labour pain. These include non-pharmacological approaches such as hypnosis, acupuncture, hydrotherapy and transcutaneous electrical nerve stimulation as well as the administration of nitrous oxide and low-dose sevoflurane and parenteral opioids. Although some of these therapies provide satisfactory pain relief from the mothers' point of view [1,2], there is evidence that neuraxial local anaesthetics and opioids yield superior and more reliable analgesia than these aforementioned methods [3,4].Although invasive, neuraxial labour analgesia is considered safe practice. Over the last decade, several improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. These developments include the introduction of combined spinal-epidural (CSE) analgesia, 'mobile epidurals', patient controlled epidural analgesia (PCEA), computer assisted injection of epidural solutions and ultrasound guided neuraxial techniques. Some of these advances have already been introduced into clinical practice while ongoing research is stimulated by the exciting clinical perspectives brought forward by other developments. This review focuses on the recent advances in neuraxial labour analgesia and on the relevant scientific literature published in the last 5 years. We performed a MEDLINE-based search of all the literature published from January 2005, using the following keywords: labour analgesia; epidural; spinal; combined spinal-epidural; pregnancy; obstetric; neostigmine; clonidine; pharmacogenetics; and breastfeeding. We focussed our research on prospective, randomised controlled trials as well as meta-analysis and further completed our review by including retrospective observational trials and case reports where relevant. For clarity of discussion and when considered necessary, we also included literature from earlier years. Initiating neuraxial analgesiaUltrasound guided neuraxial techniques Ultrasound i...

show abstract

“…Importantly, the use of higher doses of fentanyl is not associated with a bupivacaine dose‐sparing effect. The ED 95 for plain bupivacaine with 15 μg fentanyl is 1.66 μg . Since the dose we used was significantly above both ED 50 and ED 95 , we do not believe that this easily explains why a proportion of parturients in the CSE group experienced ineffective analgesia.…”

mentioning

confidence: 91%

A reply

2014

View full text Add to dashboard Cite

Determination of the ED95 for intrathecal plain bupivacaine combined with fentanyl in active labor

Cited by 16 publications

References 16 publications

Determination and Comparison of Graded Dose–Response Curves for Epidural Bupivacaine and Ropivacaine for Analgesia in Laboring Nulliparous Women

Determination and Comparison of Graded Dose–Response Curves for Epidural Bupivacaine and Ropivacaine for Analgesia in Laboring Nulliparous Women

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

A reply

Contact Info

Product

Resources

About