Emergencies in obstetric anaesthesia: a narrative review

Prior, C. H.; Burlinson, C.E.G.; Chau, Anthony

doi:10.1111/anae.15839

Cited by 4 publications

(1 citation statement)

References 116 publications

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“…Complications of neuroaxial blocks can include temporary or permanent neurological deficits, total spinal blocks, or local anesthetic toxicity. [15][16][17] One promising alternative is the Transverse Abdominal Plane (TAP) Block, which is believed to have fewer complications. 18 TAP offers benefits such as reduced medication reliance, faster thrombo-prophylaxis, earlier patient mobilization, and the elimination of motor blockade risks.…”

Section: Introductionmentioning

confidence: 99%

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Salazar-Flórez,

Arenas-Cardona,

Marhx

et al. 2024

LRA

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Background Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ( ), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

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Section: Introductionmentioning

confidence: 99%

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Salazar-Flórez,

Arenas-Cardona,

Marhx

et al. 2024

LRA

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Neumoencéfalo tras técnica espinal-epidural combinada: informe de caso

Martins de Carvalho,

Costa Antunes,

Nunes Miranda

et al. 2024

Revista Española de Anestesiología y Reanimación

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Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis

Hoerner,

Stundner,

Seisl

et al. 2024

Reg Anesth Pain Med

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IntroductionInjecting mixtures of local anesthetics with or without adjuvants is a common practise in regional and particularly obstetric anesthesia to decrease block onset time and/or augment epidural analgesia for cesarean section. While evidence on the efficacy of this practise is equivocal, little is known about its safety in terms of the pharmacologic compatibility of local anesthetics.MethodsWe assessed the grade of crystallization in individual mixtures of seven local anesthetics (bupivacaine, ropivacaine, lidocaine, procaine, chloroprocaine, mepivacaine, prilocaine) with or without four adjuvants (sodium bicarbonate, dexamethasone, clonidine, fentanyl) using a semiquantitative light microscopy scale (ranging from 0 to 5), repeatedly for up to 60 min and performed correlation analysis between grade of crystallization and initial solution pH.ResultsOf the 50 mixtures tested, 26 showed grades of crystallization ≥4 at admixture and 41 showed grades of crystallization ≥4 after 60 min. The addition of adjuvants to local anesthetic mixtures did not substantially change the grades of crystallization. Bupivacaine has a slightly lower precipitation tendency, compared with ropivacaine. A moderate relationship was found between initial pH and grade of crystallization after 15 min for the adjuvant mixtures (R=0.33, p=0.04), but not at other time points.DiscussionThe preparation of local anesthetic (±adjuvant) mixtures leads to high grades of crystallization, which increase over 60 min and appear independent of solution pH. The risk of mixing medications with unknown physical or chemical compatibility profiles in regional anesthesia should be critically appraised and its clinical significance elucidated in future translational research.

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Emergencies in obstetric anaesthesia: a narrative review

Cited by 4 publications

References 116 publications

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Neumoencéfalo tras técnica espinal-epidural combinada: informe de caso

Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis

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