Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-Gauge Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial

Wilson, Sylvia H.; Wolf, Bethany J.; Bingham, Kellie N.; Scotland, Quiana S.; Fox, John M.; Woltz, Erick M.; Hebbar, Latha

doi:10.1213/ane.0000000000002129

Cited by 69 publications

(41 citation statements)

References 17 publications

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“…This corroborates the results in this study that DXMS pretreatment is effective in reducing the incidence of postoperative lower back pain in epidural labor analgesia. In the study of Chau et al ( 16 ) and Wilson et al ( 17 ), it was shown that the number of punctures is a direct factor affecting postoperative lower back pain. Therefore, the effect of DXMS on patients with different times of punctures was investigated and it was found that either with one puncture or many times of puncture, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group.…”

Section: Discussionmentioning

confidence: 99%

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Yang

Liu

et al. 2018

Exp Ther Med

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This report aims to retrospectively analyze the clinical effect of local pretreatment with dexamethasone (DXMS) on lower back pain after epidural labor analgesia. Patients with epidural labor analgesia treated in People's Hospital of Rizhao from January 2014 to December 2016 were studied. All 368 cases involved were pregnant primipara with full-term single birth. Parturient received injection of DXMS and lidocaine mixture around the epidural puncture point was the observation group (n=188), and parturient received injection of 0.9% sodium chloride and lidocaine mixture around the epidural puncture point was the control group (n=180). The incidence and degree of lower back pain postoperatively in the two groups were evaluated by pain visual analogue scale method. The incidence of lower back pain at 48 h, 72 h after operation in observation group was significantly lower than that in control group (p<0.05). Among patients undergoing one puncture and more than one puncture, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (59.26%) (p<0.05). Among the parturient with spontaneous delivery, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (p=0.028). Among the cesarean section patients, the incidence of pain in observation group was significantly lower than that in control group (p=0.019). At 48 and 72 h after operation, severe pain in the observation group was significantly less than that in the control group (p<0.05). DXMS local pretreatment can significantly reduce the incidence of postoperative lower back pain and the degree of pain after epidural delivery analgesia. DXMS pretreatment in epidural analgesia deserved to be widely used clinically.

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Section: Discussionmentioning

confidence: 99%

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Yang

Liu

et al. 2018

Exp Ther Med

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“… 29 – 35 We illustrate the practical use of these techniques in 3 different types of studies recently published in Anesthesia & Analgesia . 29 – 31 …”

Section: Published Representative Use Of Nonparametric and Semiparamementioning

confidence: 99%

“…In their randomized controlled trial, Wilson et al 31 studied whether dural puncture epidural (DPE)—a technique where the dura is punctured but medication is not administered in the subarachnoid space—expedites analgesia in laboring patients compared to the conventional lumbar epidural (LE) technique. Adequate analgesia was defined as a score of ≤10 mm on a 100-mm Visual Analog Scale during active contractions.…”

Section: Published Representative Use Of Nonparametric and Semiparamementioning

confidence: 99%

“…The estimated HR was 1.67 (95% CI, 1.02–2.64; P = .042). 31 To make these results more understandable, the authors followed the common (albeit not statistically correct) practice of interpreting the HR as a relative risk: “The relative risk of achieving pain control at any collected time point in parturients receiving DPE was 1.7 times greater than in those receiving LE.” 31 Of note, in the above first example, observational data were analyzed using the Cox PH model to adjust for confounding. Here, in this randomized controlled trial, the purpose of the Cox PH model was to obtain an estimate of the treatment effect.…”

Section: Published Representative Use Of Nonparametric and Semiparamementioning

confidence: 99%

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Survival Analysis and Interpretation of Time-to-Event Data: The Tortoise and the Hare

Schober

Vetter

2018

Anesthesia &Amp; Analgesia

190

125

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Survival analysis, or more generally, time-to-event analysis, refers to a set of methods for analyzing the length of time until the occurrence of a well-defined end point of interest. A unique feature of survival data is that typically not all patients experience the event (eg, death) by the end of the observation period, so the actual survival times for some patients are unknown. This phenomenon, referred to as censoring, must be accounted for in the analysis to allow for valid inferences. Moreover, survival times are usually skewed, limiting the usefulness of analysis methods that assume a normal data distribution. As part of the ongoing series in Anesthesia & Analgesia, this tutorial reviews statistical methods for the appropriate analysis of time-to-event data, including nonparametric and semiparametric methods—specifically the Kaplan-Meier estimator, log-rank test, and Cox proportional hazards model. These methods are by far the most commonly used techniques for such data in medical literature. Illustrative examples from studies published in Anesthesia & Analgesia demonstrate how these techniques are used in practice. Full parametric models and models to deal with special circumstances, such as recurrent events models, competing risks models, and frailty models, are briefly discussed.

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“…DPE technique may thus provide a faster onset of labour analgesia giving a better quality, reliable, and consistent block compared with the epidural technique with less maternal and foetal side effects compared with the CSE technique. [ 24 25 ]…”

Section: Dural Puncture Epidural Techniquementioning

confidence: 99%

Neuraxial techniques of labour analgesia

Gupta

Partani

2018

Indian J Anaesth

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In recent years, many neuraxial techniques have been introduced to initiate and maintain labour analgesia, with low-dose mixtures of local anaesthetics and opioids, which have improved the quality of analgesia and made it safer for both mother and neonate. An independent search of the databases of PubMed, Medline, and Cochrane controlled trial data was conducted by two researchers, and randomized controlled trials that compared different methods of neuraxial analgesia and the different techniques of maintaining labor analgesia were retrieved and analyzed. The advantages, disadvantages, and indications of each technique along with the doses of intrathecal and epidural drugs are discussed. The myths and controversies involving neuraxial labor analgesia and the current consensus on their effect on the maternal and foetal outcomes are also outlined.

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Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-Gauge Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial

Abstract: Although the percentage of parturients achieving adequate labor analgesia at 10 minutes after epidural bolus did not differ by technique, DPE was associated with faster time to VAS ≤ 10 mm compared with LE.

Cited by 69 publications

References 17 publications

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Survival Analysis and Interpretation of Time-to-Event Data: The Tortoise and the Hare

Neuraxial techniques of labour analgesia

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