The Combined Spinal-Epidural Technique

Rawal, Narinder; Holmström, Björn; Crowhurst, John A.; Zundert, André van

doi:10.1016/s0889-8537(05)70164-4

Cited by 93 publications

(47 citation statements)

References 138 publications

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“…Subarachnoid fentanyl or sufentanyl in combined anesthesia allows for the immediate relief of the pain caused by uterine contractions without motor blockade of the lower limbs. This is one of the greatest advantages of this technique, as demonstrated by the results in Group II 4,14,17,18 . However, due its relatively short duration, of approximately 90 minutes, the dose of subarachnoid opioid is not enough for the entire period of cervical dilation and, therefore, the epidural administration of maintenance doses of the local anesthetic is necessary 9, 17,19 .…”

Section: Discussionmentioning

confidence: 79%

“…Em relação ao bloqueio motor, nenhuma paciente, em ambos os grupos, apresentou alterações que causassem dificuldades para deambulação. Considera-se que a paciente deambula quando ela caminha pelo menos cinco minutos em uma hora [13][14][15][16] . A deambulação, apesar de ser controversa em relação à diminuição do tempo do trabalho de parto, oferece à parturiente sensação de liberdade e de autocontrole, pois ela não fica restrita à mesa de parto sem poder se mover 6 .…”

Section: Discussionunclassified

“…No presente estudo, a técnica peridural contínua também não aumentou o número de operações cesarianas e a incidência foi de apenas 5%, contra 20% na técnica combinada. Uma importante vantagem da anestesia peridural contínua é a não-perfuração da dura-máter, que causaria quebra da integridade da barreira protetora do sistema nervoso central que poderia proporcionar um maior risco de disseminação de agentes infecciosos e, conseqüentemente, meningite bacteriana como em relatos da literatura 14,23 . Em ambos os grupos o anestésico local utilizado foi a bupivacaína a 0,25% em excesso enantiomérico de 50%.…”

Section: Discussionunclassified

“…There were no cases of motor blockade in both groups that would hinder ambulation. It is considered ambulation when the patient walks for at least 5 minutes in one hour [13][14][15][16] . Although there is controversy on the role of ambulation on decreasing the duration of labor, it gives the patient a feeling of freedom and self-control, since she is not restricted to the birth table 6 .…”

Section: Discussionmentioning

confidence: 99%

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Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua

Côrtes¹,

Sanchez²,

Oliveira³

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüên-cias deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO:Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náu-seas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS:Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES:Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor.Estudos clínicos com maior número de casos são necessários para avaliar diferença na incidência de cesarianas.Unitermos: ANALGESIA, Obstétrica: parto; ANESTÉSICOS, Local: bupivacaína 0,25% em excesso enantiomérico de 50%; ANALGÉSI-COS, Opióides: fentanil; TÉCNICAS ANESTÉSICAS, Regional: peridural contínua, combinada raquiperidural. SUMMARY BACKGROUND AND OBJECTIVES:Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. METHODS:Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between ...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionunclassified

Section: Discussionmentioning

confidence: 99%

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Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua

Côrtes¹,

Sanchez²,

Oliveira³

et al. 2007

Rev. Bras. Anestesiol.

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“…CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4)(5)(6)(7)(8)(9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia.…”

Section: Initiation Of Neuraxial Analgesiamentioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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