The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study

Wang, L.Z.; Chang, Xiangyang; Hu, Xiaoxia; Tang, B.L.; Xia, F.

doi:10.1016/j.ijoa.2011.06.002

Cited by 17 publications

(15 citation statements)

References 17 publications

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“…The average analgesic time (12.6 h) in the early PCEA group was significantly longer than that in the delayed group (4.8 h), and the average oral temperatures in the two groups were similar at 37.4 ± 0.4°C and 37.2 ± 0.3°C, respectively. In another study, Wang et al randomly divided parturients into immediate and delayed PCEA groups (average delay, 129 min) after spinal analgesia, and found no significant difference in the maternal fever rate between the groups [6]. Therefore, some researchers speculate that the "trigger-effect" of local anesthetics leads to intrapartum fever via non-infectious inflammation [13].…”

Section: Discussionmentioning

confidence: 99%

“…The study found that bupivacaine decreased the activity of caspase-1 in the peripheral blood mononuclear cells of laboring women, which subsequently inhibited the release of intracellular IL-1Ra by circulating leukocytes and revealed that immunomodulation by bupivacaine during labor promoted ERMF [4]. In two different studies, Wang et al found that although the average analgesic duration in the early PCEA group was significantly longer than that in the late PCEA group, the average body temperature and fever rate were almost the same [5,6]. They speculated that the relationship between PCEA and ERMF could be attributed to the "triggering effect" of local anesthetics via non-infectious inflammation.…”

Section: Introductionmentioning

confidence: 99%

“…Investigations are limited in scope due to the existing body temperature monitoring methods. In most current investigations, maternal temperature is measured at predefined time points according to cervical dilatation [7] or at regular intervals during labor [6,8]. Therefore, it is impossible to generate a precise and continuous temperature-time curve.…”

Section: Introductionmentioning

confidence: 99%

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Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

Zhao

Wang

et al. 2021

BMC Anesthesiol

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Background To investigate the relationship between intrapartum maternal fever and the duration and dosage of patient-controlled epidural analgesia (PCEA). Methods This observational study included 159 pregnant women who voluntarily accepted PCEA. During labor, patients with body temperature ≥ 38 °C were classified into the Fever group, (n = 42), and those with body temperature < 38 °C were classified into the No-fever group (n = 117). The outcome measures included the duration of PCEA, number of PCEA, and total PCEA amount. Body temperature and parturient variables, including interpartum fever status and the duration of any fever were monitored. Results The total PCEA duration and total PCEA amount in the Fever group were significantly higher than the corresponding values in the No-fever group (both, p < 0.05). The duration of fever was weakly correlated with the duration of PCEA (R2 = 0.08) and the total PCEA amount (R2 = 0.05) (both, p < 0.05). The total and effective PCEA were higher in the Fever group than in the No-fever group (both, p < 0.05). The total PCEA duration and total PCEA amount were positively correlated with the incidence of fever (both, p < 0.05). The diagnostic cutoff value for fever was 383 min, with a sensitivity of 78.6% and specificity of 57.3%. The mean temperature-time curves showed that parturients who developed fever had a steeper rise in temperature. Conclusions This study showed that there were weak time- and dose-dependent correlations between PCEA and maternal fever during delivery. A total PCEA duration exceeding 6.3 h was associated with an increase in the duration of maternal intrapartum fever.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

Zhao

Wang

et al. 2021

BMC Anesthesiol

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“…Dari penelitian ini tidak didapatkan perbedaan bermakna antara dua kelompok terhadap kenaikan suhu yang terjadi pada ibu. 29 Sebelumnya penggunaan opioid pada analgesia epidural dikatakan berhubungan dengan insidensi demam maternal yang lebih rendah. Namun penelitian yang dilakukan oleh Gross dkk mengatakan hal sebaliknya bahwa tidak ada perbedaan bermakna pada kejadian demam intraprtum antara pasien yang menggunakan opioid dan yang tidak.…”

Section: Inflamasiunclassified

Demam pada Penggunaan Analgesia Persalinan Epidural

Nugroho¹,

Uyun

Melati

2020

JAOI

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Analgesia epidural telah diperkenalkan secara rutin sebagai salah satu modalitas analgesia pada proses persalinan sejak lama. Hubungan antara analgesia epidural persalinan dengan demam intrapartum pada maternal sudah disebutkan pada beberapa literatur. Demam didefinisikan sebagai peningkatan suhu tubuh lebih dari 38 oC yang didapat dari dua kali pemeriksaan. Beberapa teori yang disebutkan antara lain perubahan termoregulasi, infeksi pada ibu-janin dan inflamasi non-infeksi yang dimediasi oleh sitokin proinflamasi. Namun demikian berbagai mekanisme analgesia epidural dapat menyebabkan demam masih terus diteliti. Identifikasi demam pada ibu saat persalinan merupakan hal yang penting untuk dilakukan karena memiliki konsekuensi klinis pada ibu dan neonatus. Pada ibu ditemukan suhu yang meningkat dikaitkan dengan peningkatan denyut jantung ibu, curah jantung, konsumsi oksigen, dan produksi katekolamin. Sedangkan pada janin demam intrapartum dapat menyebabkan sepsis, perubahan skor APGAR, peningkatan kebutuhan bantuan napas dan kejadian kejang. Efek demam pada ibu dan janin masih terus dipelajari, sehingga suatu saat didapatkan cara pencegahan yang paling baik yang pada akhirnya menghindarkan keraguan untuk melakukan analgesia persalinan. Fever during labour epidural analgesia Abstract Epidural analgesia has been routinely introduced as one of the analgesia modalities during labour. Literature has mentioned the relationship between epidural analgesia and intrapartum fever among mothers. Fever is defined as increased temperature above 38 oC in more than two measurements. Several theories have been proposed, inculing thermoregulation changes, mother-fetal infection, and non-infectious inflammation mediated by proinflammatory cytokines. However, these mechanisms have been continued to evolve. Fever identification in pregnant women is essential to recognize clinical consequences to both mothers and neonates. Increased temperature in mothers is associated with increased heart rate, cardiac output, oxygen consumption, and catecholamines production. Meanwhile, in neonates intrapartum fever is related to sepsis, APGAR score changes, the need of respiratory support and incidence of neonatal seizure. Therefore, these consequences are extensively studied in order to determine the appropriate prevention.

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“…Evidence indicated that CSEA induces a similar ERMF as EA ( 20 ). The rapidity of nerve block may or may not influence the timing of the onset of ERMF.…”

Section: Introductionmentioning

confidence: 99%

Combined spinal-epidural analgesia and epidural analgesia induced maternal fever with a similar timing during labor-A randomized controlled clinical trial

Chu

Sun²,

Bai³

et al. 2022

Front. Med.

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BackgroundBoth epidural and combined spinal-epidural (EA and CSEA) analgesia can induce intrapartum maternal fever. CSEA has a more rapid onset and wider nerve block than EA. Therefore, CSEA might have a different profile of intrapartum maternal fever, including higher temperatures or earlier occurrence. This randomized clinical trial was to determine whether CSEA could cause maternal fever earlier than EA.MethodsA randomized, double-blind, controlled clinical trial was performed on 233 nulliparous full-term pregnant women during vaginal delivery. The pregnant women were randomly allocated into the EA group (n = 113) and the CSEA group (n = 120). The fever latent period, from analgesia start to fever occurrence, was the primary endpoint in this study. The temperature was measured every 30 min using an eardrum thermometer during labor analgesia. The fever was defined as an eardrum temperature of ≥38 °C.ResultsNo difference was found in the maternal fever rate between the EA and the CSEA groups (10/113 vs. 7/120, P = 0.356). There was no significant difference in the fever latent period between the two groups (4.75 ± 0.86 h vs. 3.79 ± 2.2 h, p = 0.305). The temperatures at all points had no differences between EA and CSEA.ConclusionCSEA had a similar latent fever period as EA. A further study is warranted to confirm the similar characteristic between CSEA and EA in the development of intrapartum maternal fever.Clinical trial registrationwww.chictr.org.cn, identifier ChiCTR2000038793.

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The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study

Cited by 17 publications

References 17 publications

Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

Demam pada Penggunaan Analgesia Persalinan Epidural

Combined spinal-epidural analgesia and epidural analgesia induced maternal fever with a similar timing during labor-A randomized controlled clinical trial

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