Neuraxial analgesia and fetal bradycardia

Velde, Marc Van de

doi:10.1097/01.aco.0000169230.53067.49

Cited by 40 publications

(22 citation statements)

References 32 publications

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“…Of these, fetal bradycardia remains one of the most complex and worrying side effects of intrathecal opioids, even though it does not result in an increase in operative deliveries. 12 In a study by our group looking at higher doses of local anesthetic in a patient population similar to the present study, the incidence of fetal bradycardia was 37%. 5 Palmer and Nielson observed incidences of sustained bradycardia after intrathecal opioids of between 5 and 15% in patients at a mean cervical dilation of 5 cm 3 .…”

Section: Discussionsupporting

confidence: 77%

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

Whitty¹,

Goldszmidt²,

Parkes³

et al. 2007

International Journal of Obstetric Anesthesia

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Section: Discussionsupporting

confidence: 77%

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

Whitty¹,

Goldszmidt²,

Parkes³

et al. 2007

International Journal of Obstetric Anesthesia

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“…[5][6][7][8] In many developed countries, epidural analgesia is viewed as the preferred technique to relieve labor pain because it can be continued throughout labor and extended for operative delivery without the need for general anesthesia, allowing women to participate actively in their delivery. 4,5 Despite reports of fetal heart rate abnormalities 6,7 and maternal hypotension 8 current evidence suggests that epidural analgesia is not associated with either immediate or long-term perinatal morbidity. [9][10][11] It has therefore gained widespread acceptance with 90% of UK obstetric units offering a 24-h epidural service.…”

Section: Introductionmentioning

confidence: 99%

Awareness and desirability of labor epidural analgesia: a survey of Nigerian women

Oladokun

Eyelade

Morhason-Bello

et al. 2009

International Journal of Obstetric Anesthesia

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“…In a large RCT by Gambling et al (1998), none of the 607 parturients assigned to receive pethidine delivered by CS due to profound foetal bradycardia while there were 9 such cases in the combined spinal epidural (CSE) group of 616 parturients. According to the review by van de Velde (2005b) this is, however, the only study indicating an increase in operative deliveries due to FHR changes in neuraxial analgesia. Problematic FHR changes occur in 3.9-15.4% during CSE analgesia and 2.5-18.8% during EDA according to retrospective trials (Van de Velde 2005).…”

Section: Foetal Heart Rate (Fhr) Tracingmentioning

confidence: 96%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Neuraxial analgesia and fetal bradycardia

Cited by 40 publications

References 32 publications

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

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

Awareness and desirability of labor epidural analgesia: a survey of Nigerian women

Intravenous patient-controlled analgesia with remifentanil in early labour

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