The role of combined spinal epidural analgesia for labour: is there still a question?

Preston, Roanne

doi:10.1007/bf03021893

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…Indeed, there is no argument about its suitability in parturients in advanced labor and those in extreme pain who require rapid relief. [4][5][6][7] Apart from rapid onset analgesia, a high proportion (90%) experienced adequate analgesia that is congruous with the findings of other workers. [7][8][9][10] We had more nulliparous than parous patients requesting for CSE in contrast with Miro et al data, [7] understandably, a high proportion (62%) of our cohort received oxytocin augmentations causing extreme pain situations.…”

Section: Discussionsupporting

confidence: 84%

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Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

2015

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Section: Discussionsupporting

confidence: 84%

“…Some authors have suggested that CSE is more appropriate for late labor in parous women and should not be offered to all women. [4,5] The purpose of this study was to describe our experience with CSE in nulliparous and parous parturients in labor in order to boost its utilization for Nigerian women.…”

Section: Introductionmentioning

confidence: 99%

Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

2015

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“…CSE analgesia produces rapid anti nociception through the initial effect of intra thecal lipophilic opioids on spinal cord opioid receptors, with or without the effect of a very small dose of local anesthetic on the unsheathed nerve roots of the cauda equina. Compared with epidural analgesia alone, excellent pain relief occurs within 5-10 min (vs 10-20 min), irre spective of the stage of labor; and motor block is absent or minimal initially [71][72][73][74]. It also reduces the requirement for subsequent epidural bolus doses [74].…”

Section: Neuraxial Analgesia In Labormentioning

confidence: 95%

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Tulp

Paech

2013

Pain Manage.

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It is widely recognized that childbirth may be the most painful experience in a woman's lifetime and that women have a right to relief. There are many options, but the efficacy of only a few is supported by robust evidence. Many influences determine which method of pain relief is chosen, including social and cultural factors, availability, cost and personal preference. Due to human diversity and the differing perspectives of consumers, obstetric care providers and health administrators, there is no such thing as 'an ideal approach'. In resource-rich societies, major advances in parturient safety and outcome flow from technique development and better monitoring. Greater awareness of the negative impact of untreated pain and of the relevance of genetic, cultural and social factors motivates research into better predictive models, novel therapies and optimization of existing methods.

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“…3,4 The causes of fetal bradycardia in this setting are uncertain but may be associated with a number of factors, including a reduction in uteroplacental blood flow from the sympathetic block induced by CSE; reductions in uterine blood flow secondary to uterine overactivity, which can be caused by rapid onset analgesia leading to a catecholamine imbalance; and/or rapid decent of the neonate's head causing a fetal vagal response. 5,6 Other possible causes of profound fetal bradycardia, not associated with CSE, include compression of the umbilical cord and, in rare cases, maternal seizures.…”

Section: Résumémentioning

confidence: 99%

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study

Gambling

Bender

Faron

et al. 2015

Can J Anesth/J Can Anesth

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Background The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB.Methods We conducted this clinical trial at a large community hospital and enrolled healthy patients requesting epidural analgesia for labour. Patients were randomly assigned to receive either normal saline placebo or ephedrine 10 mg iv at the time of CSE. The primary outcome of EPFB (defined as bradycardia \ 90 beatsÁmin -1 for [ two minutes and occurring within the first 30 min after CSE) was compared between groups. The secondary outcomes included the incidence of urgent cesarean delivery, the requirement for additional doses of ephedrine, maternal blood pressure, uterine hypertonus and tachysystole, and abnormal fetal heart rate (FHR) patterns before and after CSE. Results There were 299 women randomized to the ephedrine (EPH) group and 297 randomized to the normal saline placebo (NS) group. There was no difference between groups in the incidence of EPFB (2.7% EPH group vs 4.7% NS group; relative risk, 0.57; 95% confidence interval, 0.24 to 1.33; P = 0.184). There was also no difference between groups in the incidence of -015-0450-8 urgent cesarean delivery, uterine hypertonus, uterine tachysystole, and abnormal FHR patterns. Conclusions We conclude that prophylactic intravenous ephedrine administration at the time of CSE during labour was ineffective at reducing the risk for EPFB associated with CSE. Nevertheless, a lower than expected rate of EPFB resulted in the trial being underpowered. This trial was registered at ClinicalTrials.gov, identifier: NCT02062801.123 Can J Anesth/J Can Anesth (2015) 62:1201-1208 DOI 10.1007/s12630 RésuméContexte La technique rachidienne et péridurale combinée (RPC) pour soulager la douleur lors de l'accouchement procure à la fois un court délai d'action et une analgésie supérieure pour la première étape du travail obstétrical. Cependant, le risque accru connu de bradycardie foetale profonde précoce (BFPP) après une RPC est une inquiétude qui contribue bien souvent à freiner son utilisation. L'objectif de cette étude était de déterminer si l'administration prophylactique d'éphédrine intraveineuse au moment de l'administration de la RPC réduisait la BFPP. Méthode Nous avons réalisé cette étude clinique dans un hô pital communautaire d'envergure et enrô lé des patientes ayant demandé une analgésie péridurale pour le travail obstétrical. Les patientes ont été aléatoirement réparties en deux groupes et ont reçu soit un placebo de sérum physiologique ou 10 mg iv d'éphédrine au moment de la RPC. Nous avons comparé notre critère d'évaluation principal, la BFPP (définie comme une bradycardie \ 90 battementsÁmin -1 pour [ 2 minutes et survenant au co...

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The role of combined spinal epidural analgesia for labour: is there still a question?

Cited by 18 publications

References 19 publications

Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study

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