Reducing breakthrough pain during labour epidural analgesia

Tan, Howe‐Siang; Sng, Ban Leong; Sia, Alex Tiong Heng

doi:10.1097/aco.0000000000000713

Cited by 20 publications

(11 citation statements)

References 60 publications

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“…Severe acute pain during labor is an important incentive of postpartum persistent pain which may have serious interference with a number of women's daily life (2). Epidural analgesia is one of the most safe and effective methods for labor analgesia, providing effective pain relief during labor and may decrease the occurrence of cesarean delivery (3)(4)(5). and it can be administered in different ways.…”

Section: Introductionmentioning

confidence: 99%

The effect of programmed intermittent epidural bolus compared with continuous epidural infusion in labor analgesia with ropivacaine: a meta-analysis of randomized controlled trials

et al. 2021

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Background: Programmed intermittent epidural bolus (PIEB) as a new technique for labor analgesia has aroused extensive attention. The character of separation of the motor block to sensory block makes ropivacaine becoming an important local anesthetic for labor analgesia. In this meta-analysis, we aimed to assess the efficiency and safety of PIEB regime compared to continuous epidural infusion (CEI) regime on labor analgesia with ropivacaine following the evidence emerged newly. Methods: PubMed, EMBASE and the Cochrane library were searched for potential articles. Eligible studies should meet these criterions: (I) healthy women; (II) it should compare PIEB and CEI; (III) ropivacaine should be use as local anesthetic for the maintenance of analgesia; (IV) the study should report the any of the outcomes we need. Maternal satisfaction, consumption of ropivacaine and duration of labor as well as the adverse effect were used to measure the efficacy and safety of those two regimes. Mean difference (MD), relative risk (RR), 95% confidence intervals (CI) were used to present the final results.Results: Ten articles of randomized controlled trials and 3,790 subjects were eventually included in study.The pooled results showed that PIEB with ropivacaine significantly improved satisfaction (MD, 7.87; 95% CI: 6.02 to 9.72; I 2 =0%; P<0.001), reduced the local anesthetic (milligram) in total (MD, −10.37 milligrams; 95% CI: −17.70 to −3.03; I 2 =94%; P<0.001) and hourly (MD, −1.80 milligrams; 95% CI: −2.62 to −0.98; I 2 =56%; P<0.001). PIEB shortened the second stage of labor but has similar total duration of labor and it also decrease the incidence of motor block compare to CEI. There were no differences in mode of delivery and rescue bolus between two groups.Conclusions: This study shows that PIEB regime was associated with higher satisfaction, lower consumption of ropivacaine in hours and totally, and shorter duration of second stage of labor compared to CEI in analgesia with ropivacaine during childbirth. PIEB regime has greater safety on fetus and maternity than CEI regime and it decreased the incidence of motor block without increasing other side effects compared to CEI.

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Section: Introductionmentioning

confidence: 99%

The effect of programmed intermittent epidural bolus compared with continuous epidural infusion in labor analgesia with ropivacaine: a meta-analysis of randomized controlled trials

et al. 2021

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“…The patient should be positioned in the sitting flexed position to minimise the distance to the epidural space. Ultrasonography may help identify the insertion point, angle of insertion, depth to space and reduce the number of neuraxial attempts and failed epidural catheters [38]. All practicable measures to ensure adequate neuroblockade should be taken, including the use of techniques such as combined spinal‐epidural or dural‐puncture epidural techniques that have better success rates compared with epidural only techniques [38].…”

Section: Management Of Pregnancy In the Obese Parturientmentioning

confidence: 99%

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Tan

Habib

2021

Anaesthesia

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Summary The prevalence, healthcare and socio‐economic impact of obesity (defined as having a body mass index of ≥ 30 kg.m‐2) are disproportionately higher in women than men. A combination of biological and social factors, including the adaptation of energy homeostasis to the increased demands of pregnancy and lactation and poor access to healthy foods or exercise facilities, contribute to the increasing prevalence of obesity in women. Obesity‐related physiological changes stem from mass loading and increased metabolism of adipose tissue, as well as secretion of bioactive substances from adipocytes leading to chronic low‐grade inflammation. As a result, obesity is associated with increased risks of: infertility; malignancy; sleep‐disordered breathing; cardiovascular disease; diabetes; and thromboembolism. Hence, obese women are at markedly increased risk of peri‐operative morbidity and mortality and require comprehensive evaluation and targeted comorbidity optimisation by a multidisciplinary team. In addition to routine obstetric challenges, pregnancy in women with obesity further exacerbates the above risks, making multidisciplinary management starting at pre‐conception even more important. Weight loss, lifestyle management and optimisation of comorbidity are the cornerstone of reducing obesity‐related risks. The anaesthetist plays a vital role within the multidisciplinary team by emphasising weight loss as part of pre‐operative comorbidity optimisation, formulation of individualised peri‐operative management plans, supervising postoperative care in the high dependency or intensive care settings and providing safe labour analgesia and careful peripartum management for obese parturients.

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“…Although there are conflicting reports on whether obesity is an independent risk factor for maternal mortality [2,20 ▪ ], obese pregnant patients are at a much higher risk of associated pregnancy complications such as preeclampsia, gestational diabetes, as well as macrosomic neonates, which may increase the incidence of emergency cesarean and instrumented delivery which require anesthetic intervention [21]. At the same time, obese individuals have an increased risk of breakthrough pain with labor epidural analgesia and increased difficulty with labor epidural placement [22 ▪ ]. A study of obese women referred for antenatal obstetric anesthesia consultation in Australia showed nulliparous obese women may have increased benefit from evaluation as these patients had decreases in both their decisional conflict scores and anxiety measures regarding neuraxial anesthesia prior to delivery [21].…”

Section: Identifying Patients For Referralmentioning

confidence: 99%

Peripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality

Gitterman¹,

Klaus²,

Williams³

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of review Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. Recent findings Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population. Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide useful tools to ascertain high-risk parturients for a referral to antenatal obstetric anesthesiology clinics and higher levels of maternal care. Major obstetric organizations have identified and laid out criteria for maternal level of care. Anesthesiology resources also play a role in these designations and can help triage patients to facilities with appropriate resources. Summary Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.

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Reducing breakthrough pain during labour epidural analgesia

Cited by 20 publications

References 60 publications

The effect of programmed intermittent epidural bolus compared with continuous epidural infusion in labor analgesia with ropivacaine: a meta-analysis of randomized controlled trials

The effect of programmed intermittent epidural bolus compared with continuous epidural infusion in labor analgesia with ropivacaine: a meta-analysis of randomized controlled trials

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Peripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality

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