Extending low‐dose epidural analgesia for emergency Caesarean sectionA comparison of three solutions

Lucas, D.N.; Ciccone, G.; Yentis, S. M.

doi:10.1046/j.1365-2044.1999.01108.x

Cited by 72 publications

(64 citation statements)

References 13 publications

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“…12 However, in recent studies, inadequate surgical anesthesia after conversion of ELA to ESA for CD necessitated conversion to GA in 2.5-20% of cases and provision of additional analgesia was even more frequent. [13][14][15][16][17][18][19] Only one underpowered study reported a conversion rate to GA of 0%. 20 In fact, inadequate ESA has led to litigation against anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Visser

Dijkstra

Albayrak

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Failed conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery (CD) has been observed in clinical practice. However, spinal anesthesia (SA) in parturients experiencing failed conversion of ELA to ESA has been associated with an increased incidence of serious side effects. In this retrospective cohort analysis, we examined our routine clinical practice of removing the in situ epidural, rather than attempting to convert to ESA, prior to administering SA for intrapartum CD. Methods Hemodynamic data, frequencies of either high or total spinal block, and maternal and neonatal outcome data were gathered from the anesthesia records of all parturients at the Amphia Hospital, undergoing intrapartum CD between January 1, 2001 and May 1, 2005. Results Complete data were available for 693 patients (97.6%) of the 710 medical records that were identified. Of the 693 patients, 508 (73.3%) had no ELA and received SA, 128 patients (18.5%) received SA following epidural anesthesia for labor, 19 (2.7%) underwent conversion of ELA to ESA, and 38 (5.5%) received general anesthesia. When comparing both SA groups, no clinically relevant differences were observed regarding the incidence of total spinal block (0% in both groups) or high spinal block (0.2 vs 0.8%, P = 0.36). The number of hypotensive episodes, the total amount of ephedrine administered, and the Apgar scores recorded at 5 and 10 min were similar amongst groups. Conclusions The incidence of serious side effects associated with SA for intrapartum CD following ELA is low and not different compared to SA only. RésuméObjectif Dans la pratique clinique, l'e´chec du passage d'une analge´sie pe´ridurale pour le travail obste´trical a`une anesthe´sie pe´ridurale chirurgicale pour un accouchement par ce´sarienne a e´te´observe´. Cependant, la rachianesthe´sie re´alise´e chez les parturientes chez qui la conversion de la pe´ridurale avait e´choue´a e´te´associe´e à une incidence accrue d'effets secondaires graves. Dans cette analyse de cohorte re´trospective, nous avons examineń otre pratique clinique habituelle, qui consistait a`retirer le cathe´ter pe´ridural avant de re´aliser une rachianesthe´sie pour un accouchement par ce´sarienne, plutôt que de tenter une conversion de la pe´ridurale.

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Section: Discussionmentioning

confidence: 99%

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Visser

Dijkstra

Albayrak

et al. 2009

Can J Anesth/J Can Anesth

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“…These have been in varying study populations with different epidural regimens in labour, and have used different sensory modalities and end-points for surgical anaesthesia [1,2,4,5,14], making it difficult to compare studies. We attempted to define our end-points more clearly by specifying 'icy' cold sensation and 'strong' touch sensation, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…A power analysis was performed with values for alpha and beta of 0.05 and 0.2, respectively, based on a 50% relative decrease in intra-operative supplementation, and a 30% reduction in onset time, using data from previous studies [1,2]. This indicated sample sizes of 82 and 86, respectively, hence the planned sample size of 100 per group to account for drop-outs.…”

Section: Methodsmentioning

confidence: 99%

“…Various solutions of local anaesthetic are used for this purpose. Previous work at our hospital has shown that lidocaine and ropivacaine offer no consistent advantage over bupivacaine for extending epidural analgesia for emergency Caesarean section [1,2]. Recently in our unit, levobupivacaine has replaced bupivacaine as the standard top-up solution for Caesarean section on account of its similar efficacy with less cardiotoxicity [3].…”

mentioning

confidence: 99%

“…Recently in our unit, levobupivacaine has replaced bupivacaine as the standard top-up solution for Caesarean section on account of its similar efficacy with less cardiotoxicity [3]. Addition of other drugs to the local anaesthetic has also been described, for example adrenaline, bicarbonate and opioids such as fentanyl [1,4,5]. However, mixing drugs in emergency situations risks errors [6] and mixing itself may cause delay [7].…”

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confidence: 99%

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Extending low‐dose epidural analgesia in labour for emergency Caesarean section – a comparison of levobupivacaine with or without fentanyl*

Malhotra

Yentis

2007

Anaesthesia

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SummaryWomen in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 lg.ml )1 fentanyl followed by 10-15-ml top-ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 lg fentanyl (1.5 ml) or 1.5 ml saline. Further top-ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side-effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife-administered top-ups to patient-controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra-operative nausea ⁄ vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra-operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.

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Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Emmett¹,

Cyna²,

Andrew³

et al. 2002

Cochrane Database of Systematic Reviews

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Extending low‐dose epidural analgesia for emergency Caesarean sectionA comparison of three solutions

Cited by 72 publications

References 13 publications

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Extending low‐dose epidural analgesia in labour for emergency Caesarean section – a comparison of levobupivacaine with or without fentanyl*

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

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