Speed of Onset of Regional Analgesia in Labour: A Comparison of the Epidural and Spinal Routes

Nickells, James; Vaughan, David J.; Lillywhite, N.; Loughnan, B.A.; Hasan, Muazzam; Robinson, P.N.

doi:10.1097/00006254-200009000-00008

Cited by 6 publications

(9 citation statements)

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“…Researchers using 0.125% bupivacaine plus 50mg sufentanil have found lower motor blockade in epidural than in CSE parturients 16 . In our study, in addition to local anesthetic, decreased motor blockade (ropivacaine) with a smaller dose was found.…”

Section: Discussionmentioning

confidence: 99%

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Nakamura¹,

Ganem²,

Rugolo³

et al. 2009

Rev. Assoc. Med. Bras.

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Summary objectIve. Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. Methods. Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. results. There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. conclusIon. EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

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Section: Discussionmentioning

confidence: 99%

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Nakamura¹,

Ganem²,

Rugolo³

et al. 2009

Rev. Assoc. Med. Bras.

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“…3,49,74,87,[91][92][93][94] Thus, the increased risk of FHR abnormalities must be considered before using subarachnoidal injection of opioids. 64 analgesia.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…3,7,48,49,60,64,87 Efficacy and potential side effects are the same as for spinal and epidural analgesia separately. 87,91,92,94 Theoretically, this combination of the two neuraxial methods should be an advantage: fast onset, reliable and high-quality analgesia, and high maternal satisfaction. 64 But several previous studies have concluded that overall CSE-and epidural analgesia are comparable regarding efficacy, safety and maternal satisfaction.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…64 But several previous studies have concluded that overall CSE-and epidural analgesia are comparable regarding efficacy, safety and maternal satisfaction. 49,87,92,96 Increased costs due to equipment needs and close follow up must also be weighed against potential positive effects by use of CSE. 91,92 Other nerve blocks By use of a local anesthetic, both paracervical block and blockade of the pudendal nerve can be utilized as supplement to alleviate pain during labour and delivery.…”

Section: Regional Analgesiamentioning

confidence: 99%

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Remifentanil as analgesia for labour pain

Tveit

2013

Acta Anaesthesiol Scand

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Background To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil intravenous patient‐controlled analgesia (IVPCA) for pain relief during labour. To compare remifentanil IVPCA with epidural analgesia (EDA) regarding efficacy and safety during labour. Methods In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study period (2005–2008). Paper II is a prospective, observational study of analgesic efficacy and safety with remifentanil IVPCA. Paper III is a prospective, randomized controlled trial comparing remifentanil IVPCA with EDA regarding analgesic efficacy and safety. Results The surveys in paper I found the frequency of EDA in Norwegian hospitals to be increasing, but still low (25.9%) compared with other western countries. Nitrous oxide and traditional systemic opioids, like pethidine, were frequently used. In paper II, remifentanil IVPCA was found to give satisfactory labour analgesia in more than 90% of the parturients with an average maximal pain reduction of 60%. Maternal oxygen desaturation and sedation were acceptable, and neonatal data reassuring. In paper III, a randomized controlled trial found remifentanil IVPCA and EDA to be comparable both regarding analgesic efficacy (pain reduction; Fig. ) and maternal satisfaction. Remifentanil IVPCA produced more maternal sedation and oxygen desaturation; neonatal outcome was reassuring in both groups. Reduction in pain score [visual analogue scale (VAS)] during labour analgesia with patient‐controlled intravenous remifentanil and continuous epidural infusion with ropivacaine and fentanyl. Conclusion The frequency of epidural labour analgesia in Norway has increased, but is still relatively low. Nitrous oxide and traditional systemic opioids are frequently used. The clinical practice seems conservative; newer short‐acting opioids are seldom used for systemic labour analgesia. The studies on remifentanil IVPCA revealed adequate pain relief, high maternal satisfaction, and no serious neonatal side effects. There were no differences in analgesic efficacy, maternal satisfaction, and neonatal outcome when comparing remifentanil IVPCA with EDA. However, remifentanil caused maternal sedation and oxygen desaturation. We recommend the use of IVPCA remifentanil as labour analgesia instead of traditional opioids as pethidine and morphine when EDA is not an option. The presence of skilled personnel and close monitoring is mandatory.

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“…3 Since epidural analgesia is an important component of the combined spinalepidural technique, sufentanil for intrathecal injection would be taken from the same vial at no additional costs. In providing labour analgesia, anesthesiologists should reconsider choosing a more expensive technique with inherent risks and with no clinically significant benefit in properly designed trials, 4 and then try to save these additional costs by opting for a potentially more harmful drug. We therefore propose to use epidural analgesia with sufentanil for labour, leaving the dura intact, and saving money.…”

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confidence: 99%