58 results match your criteria Labor and Delivery Analgesia Regional and Local


Pain Management in Labor.

Am Fam Physician 2021 03;103(6):355-364

Lawrence Family Medicine Residency Program, Lawrence, MA, USA.

A patient's sense of empowerment and control is most predictive of maternal satisfaction with childbirth. Analgesia during labor greatly affects this experience. Individual patient priorities for labor pain management should be explored as part of routine prenatal care. Read More

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Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review.

Anaesthesia 2021 Jan;76 Suppl 1:136-147

Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA, USA.

This narrative review discusses recent evidence surrounding the use of regional anaesthesia in the obstetric setting, including intrapartum techniques for labour and operative vaginal delivery, and caesarean delivery. Pudendal nerve blockade, ideally administered by an obstetrician, should be considered for operative vaginal delivery if neuraxial analgesia is contraindicated. Regional techniques are increasingly utilised in clinical practice for caesarean delivery to minimise opioid consumption, reduce pain, improve postpartum recovery and facilitate earlier discharge as part of enhanced recovery protocols. Read More

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January 2021

COVID in obstetrics: labor analgesia and cesarean section.

Curr Opin Anaesthesiol 2021 Feb;34(1):62-68

Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.

Purpose Of Review: This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers.

Recent Findings: COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Read More

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February 2021

Labour analgesia: update and literature review.

Hong Kong Med J 2020 10 17;26(5):413-420. Epub 2020 Sep 17.

Department of Anaesthesiology, The University of Hong Kong, Hong Kong.

Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Read More

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October 2020

Epidural versus non-epidural or no analgesia for pain management in labour.

Cochrane Database Syst Rev 2018 05 21;5:CD000331. Epub 2018 May 21.

Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-under-Lyne, UK, OL6 9RW.

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. Read More

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The effect of addition of dexamethasone to levobupivacaine in parturients receiving combined spinal-epidural for analgesia for vaginal delivery.

Indian J Anaesth 2017 Jul;61(7):556-561

Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background And Aims: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia.

Methods: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Read More

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The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature.

Cureus 2017 May 10;9(5):e1240. Epub 2017 May 10.

Anesthesiology, Riverside University Health System Medical Center, Moreno Valley, California, United States.

There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Read More

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Continuous spinal labor analgesia for two deliveries in a parturient with severe subvalvular aortic stenosis.

J Anesth 2016 12 22;30(6):1067-1070. Epub 2016 Aug 22.

Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, 1-15-1 Kitasato Minami-ku, Sagamihara City, Kanagawa, 252-0375, Japan.

Various degrees of left ventricular outflow tract (LVOT) obstruction have been seen in patients with subvalvular aortic stenosis (SAS). Regional analgesia during labor for parturients with SAS is relatively contraindicated because it has a potential risk for hemodynamic instability due to sympathetic blockade as a result of vasodilation by local anesthetics. We thought continuous spinal analgesia (CSA) using an opioid and minimal doses of local anesthetic could provide more stable hemodynamic status. Read More

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December 2016

Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report.

Local Reg Anesth 2015 6;8:7-10. Epub 2015 May 6.

Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.

Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1-L2 space, followed by an intravenous administration of ketamine (0. Read More

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Randomized trial of anaesthetic interventions in external cephalic version for breech presentation.

Br J Anaesth 2015 Jun 10;114(6):944-50. Epub 2015 May 10.

Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.

Background: Successful external cephalic version (ECV) for breech presenting fetus reduces the need for Caesarean section (CS). We aimed to compare the success rate of ECV with either spinal anaesthesia (SA) or i.v. Read More

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Anesthesia for cesarean delivery in the Czech Republic: a 2011 national survey.

Anesth Analg 2015 Jun;120(6):1303-8

From the *Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic; Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine, Prague, Czech Republic; †1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine, Prague, Czech Republic; ‡2nd Faculty of Medicine, Charles University and Motol University Hospital in Prague, Prague, Czech Republic; Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine, Prague, Czech Republic; §University Hospital Brno, Brno, Czech Republic; Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine, Prague, Czech Republic; and ‖Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.

Background: The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic.

Methods: In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). Read More

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Intrapartum epidural analgesia and onset of lactation: a prospective study in an Italian birth centre.

Matern Child Health J 2015 Mar;19(3):511-8

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Manfredo Fanti, 6, 20122, Milan, MI, Italy,

The objective of this study is to investigate the relationship between epidural analgesia (EDA) in labor and the onset of lactation in healthy women after birth. In a Regional Perinatal Center in northern Italy, women who had had a vaginal delivery were recruited by convenience sampling. Analyses were carried out on the data of 366 women. Read More

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[Anesthetic management of parturients with peripartum cardiomyopathy].

Masui 2014 Jan;63(1):31-8

Department of Obstetric Anesthesia, National Center for Child Health and Development, Tokyo 157-8535.

Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women, and is becoming the leading cause of maternal death in U.S.A and U. Read More

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January 2014

The effect of neuraxial anesthesia on maternal cerebral hemodynamics.

Am J Perinatol 2014 Oct 11;31(9):787-93. Epub 2013 Dec 11.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.

Objective: Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Read More

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October 2014

Analgesia in Obstetrics.

Authors:
M Heesen M Veeser

Geburtshilfe Frauenheilkd 2012 Jul;72(7):596-601

Anesthesiology, Sozialstiftung Bamberg, Bamberg.

An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Read More

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Labor analgesia.

Am Fam Physician 2012 Mar;85(5):447-54

University of Tennessee Health Science Center, Saint Francis Family Medicine Residency, Memphis, TN 38119, USA.

Regional analgesia has become the most common method of pain relief used during labor in the United States. Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space, and the patient receives a continuous infusion or multiple injections of local anesthetic. Read More

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Epidural technique for postoperative pain: gold standard no more?

Authors:
Narinder Rawal

Reg Anesth Pain Med 2012 May-Jun;37(3):310-7

From the Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.

Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. Read More

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Epidural versus non-epidural or no analgesia in labour.

Cochrane Database Syst Rev 2011 Dec 7(12):CD000331. Epub 2011 Dec 7.

Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-under-Lyne, UK, OL6 9RW.

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant.

Objectives: To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour. Read More

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December 2011

Maternal ambulation during labor.

Curr Opin Anaesthesiol 2011 Jun;24(3):268-73

University College London Hospital, London, UK.

Purpose Of Review: To describe the recent advances in labor epidural analgesia, which may have an impact on maternal ambulation during labor.

Recent Findings: With the advent of new epidural adjuvant drugs and new epidural delivery systems, we are now able to use very low concentration local anesthetic solutions with a reduction in the total doses of local anesthetic administered. This allows a much greater preservation of lower limb motor function in the parturient, with a subsequent positive effect on maternal ambulation. Read More

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Anesthetic management of spinal muscle atrophy type II in a parturient.

Local Reg Anesth 2011 6;4:15-20. Epub 2011 Apr 6.

Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.

We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature. Read More

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October 2012

Advances in labor analgesia.

Authors:
Cynthia A Wong

Int J Womens Health 2010 Aug 9;1:139-54. Epub 2010 Aug 9.

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. Read More

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[Quality indicator survey of anaesthesia records in hospitals of Aquitaine].

Ann Fr Anesth Reanim 2008 Mar 14;27(3):216-21. Epub 2008 Feb 14.

CCECQA, hôpital Xavier-Arnozan, 33604 Pessac cedex, France.

Objectives: Assessing the quality of anaesthesia records according to the criteria of the reference frame of professional practices evaluation proposed by the French Anaesthetists College (Cfar) in 2005.

Study Design: Retrospective, multicentric study.

Materials And Methods: Fifty anaesthesia records were randomly selected from each of the 64 health care settings in Aquitaine with an inpatient surgery activity. Read More

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[Anaesthesia, a cause of fetal distress?].

Ann Fr Anesth Reanim 2007 Jul-Aug;26(7-8):694-8. Epub 2007 Jun 14.

Département d'anesthésie-réanimation, hôpital Antoine-Béclère, APHP, Clamart cedex, France.

Objective: To describe the effects of anaesthetic techniques and agents on the risk of fetal distress during labour pain relief and anaesthesia for caesarean section.

Study Design: Data on obstetric anaesthesia- and analgesia-induced fetal distress were searched in Medline database using MESH terms: fetal distress, anaesthesia, analgesia, labour, caesarean section, and umbilical artery pH. Trials published in English or French language were selected. Read More

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October 2007

Case report: Successful labour epidural analgesia in a patient with spinocerebellar ataxia.

Can J Anaesth 2007 Jun;54(6):467-70

Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Room 781, Toronto, Ontario M5G 1X5, Canada.

Purpose: To report the favourable outcome associated with epidural analgesia in a parturient with spinocerebellar ataxia (SCA).

Clinical Features: A 34-yr-old patient, G2 P0, presented at term with a history of SCA since the age of 22 characterized by slurred speech, balance and gait disturbances, diplopia and nystagmus. A magnetic resonance imaging of the brain at the age of 27 showed cerebellar degeneration. Read More

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[Combined spinal-epidural anaesthesia for pain relief in obstetric patients].

Authors:
Thomas Standl

Anasthesiol Intensivmed Notfallmed Schmerzther 2007 May;42(5):342-9

Klinik für Anästhesie und operative Intensivmedizin, Städtischen Klinikums Solingen, Akademisches Lehrkrankenhaus, Universität Köln, Germany.

Besides epidural analgesia combined spinal-epidural anaesthesia (CSE) is one of the favourite techniques of regional anaesthesia for pain relief in obstetric patients. CSE combines the advantage of spinal anaesthesia, e.g. Read More

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Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia.

Int J Obstet Anesth 2007 Jul 16;16(3):226-30. Epub 2007 May 16.

Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besveler, Ankara, Turkey.

Background: The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia.

Methods: Forty ASA I parturients at 37-42 weeks' gestation and cervical dilatation <6 cm were randomly allocated to receive either epidural analgesia (group EA) or combined spinal-epidural analgesia (group CSEA). Analgesia was initiated with a 7-mL epidural bolus 0. Read More

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Cesarean section in a patient with familial cardiomyopathy and a cardioverter-defibrillator.

Can J Anaesth 2006 May;53(5):478-81

Department of General Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, E-31, Cleveland, Ohio 44195, USA.

Purpose: To describe the impact of maternal automatic implantable cardioverter-defibrillator (AICD) therapy on pregnancy outcome, and discuss the clinical rationale for regional anesthesia in parturients with AICDs.

Clinical Features: A 20-yr-old primigravida with a history of familial cardiomyopathy and AICD placement presented at 39 weeks gestational age for elective labour induction. Ultimately, the patient underwent a Cesarean section for a failed induction. Read More

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Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience.

Int J Obstet Anesth 2006 Apr 20;15(2):115-23. Epub 2006 Feb 20.

Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.

Background: There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis.

Methods: Following Obstetric Anaesthetists' Association approval a questionnaire was sent to UK consultant members. Read More

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Similar onset time of 2-chloroprocaine and lidocaine + epinephrine for epidural anesthesia for elective Cesarean section.

Acta Anaesthesiol Scand 2006 Mar;50(3):358-63

Department of Anesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway.

Background: The use of regional anesthesia for elective Cesarean section has been demonstrated to be safe for both the mother and new-born. In parturients with an epidural catheter placed previously for labor analgesia, extension of the epidural block may be the preferred option, provided that adequate speed of onset and adequate surgical anesthesia are obtained. We therefore performed a prospective, randomized, double-blind trial to examine the speed of onset and anesthetic quality of 2-chloroprocaine vs. Read More

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The effects of continuous epidural analgesia on Doppler velocimetry of uterine arteries during different periods of labour analgesia.

Br J Anaesth 2006 Feb 23;96(2):226-30. Epub 2005 Dec 23.

Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.

Background: The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0. Read More

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February 2006