Parturients' assessment of water blocks, pethidine, nitrous oxide, paracervical and epidural blocks in labour

Intravenous patient-controlled analgesia with remifentanil in early labour

“…There seems to be a steep fall in pain scores (0-10) from 7.1-7.9 to 0-4 during the first hour (Thorp et al 1993, Bofill et al 1997, Jain et al 2003) with a sustained effect throughout the 1 st stage of labour. Most studies compared EDA with systemic pethidine which has been thought to provide near to no analgesia at all in labour pain (Olofsson et al 1996b, Ranta et al 1994. A decrease of pain by 0-4 with systemic opioid analgesia from a baseline pain score of 6.9-9 on a scale of 0-10 has been noted, however, in several large studies (Thorp et al 1993, Ramin et al 1995, Sharma et al 1997, Bofill et al 1997, Jain et al 2003 (table 2).…”

“…In RCTs comparing epidural with opioid analgesia, a larger proportion (73-95%) of mothers in the epidural groups stated that they Table 1 would opt for a similar analgesia in any future labour compared with 30-70% of the women in the opioid groups (table 2). In a nonrandomised study, Ranta et al (1994) noted that no mothers (0 out of 82) assessed their EDA analgesia as being poor (three category VRS: good, moderate, poor) on the third day after delivery compared with all other methods included in the study (water blocks 15%, nitrous oxide 28%, pethidine 17%, paracervical block 15%).…”

A reply

“…Feneley and co-workers demonstrated that stroke work falls to a greater degree than does end-systolic pressure during preload reduction [5], thus providing a greater amount of information with which to extrapolate the slope of the stroke work against end-diastolic volume, with improved accuracy of slope estimation when compared with other load-independent indices of contractility. Mirsky et al recently discussed the importance of both the slope and the intercept in the interpretation of contractility [6]. The problem of negative intercepts remains a major caveat in the interpretation of these indices.…”

“…Epidural analgesia is the most effective method of pain relief available. It is, however, the most invasive and certainly has the most serious, though rare, complications [6]. Ideally, a parturient should receive accurate information months before the time of delivery on all forms of analgesia available, allowing an informed decision to be made when labour occurs.…”

“…The systolic myocardial velocity taken at the level of the mitral annulus is a descriptor of systolic function rather than of contractility [5]. Echocardiographic parameters must be utilised with caution in view of load-dependency [6], which is nearly always present in critically ill patients, both in the ICU and during major surgery.…”