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Jaafarpour M, Vasigh A, Najafi F, Sayadi H, Shafiei E. A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis. Anesth Pain Med 2023; 13:e134732. [PMID: 38021336 PMCID: PMC10664161 DOI: 10.5812/aapm-134732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 12/01/2023] Open
Abstract
Context The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. Evidence Acquisition PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. Results There was no statistically significant difference in hypotension, bradycardia, and Apgar score between the 2 groups (P > 0.05). The risk of nausea (relative risk (RR), 1.526; 95% CI, 1.175 - 1.981; P = 0.001) and vomiting (RR, 1.542; 95% CI, 1.048 - 2.268; P = 0.02) caused by bupivacaine was 0.53% and 0.54% higher than that of ropivacaine. The incidence of shivering (RR, 2.24; 95% CI, 1.480 - 3.39; P = 0.00) was 2.24 times higher in the bupivacaine group than in the ropivacaine group. The average onset time of sensory block (standardized mean difference (SMD), -0.550; 95% CI, -1.054 to -0.045; P = 0.032) and motor block (SMD, -0.812; 95% CI, -1.254 to -0.371; P = 0.000) was significantly lower in the bupivacaine group than in the ropivacaine group. Conclusions Despite the fact that ropivacaine and bupivacaine are effective in cesarean section, ropivacaine is more favorable because of less hemodynamic changes, less duration of sensory and motor block, and fewer side effects, which are effective in patient recovery.
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Affiliation(s)
- Molouk Jaafarpour
- Department of Midwifery, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Aminolah Vasigh
- Department of Anesthesiology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatemeh Najafi
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Hojat Sayadi
- Department of Biostatistics, School of Health, Ilam University of Medical Sciences, Ilam, Iran
- Non-communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Elham Shafiei
- Clinical Research Development Unit, Ayatollah Taleghani Hospital, Ilam University of Medical Sciences, Ilam, Iran
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Deepak D, Kumari A, Mohanty R, Prakash J, Kumar T, Priye S. Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study. Cureus 2022; 14:e26090. [PMID: 35875290 PMCID: PMC9295827 DOI: 10.7759/cureus.26090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/05/2022] Open
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Joensuu J, Saarijärvi H, Rouhe H, Gissler M, Ulander VM, Heinonen S, Torkki P, Mikkola T. Maternal childbirth experience and pain relief methods: a retrospective 7-year cohort study of 85 488 parturients in Finland. BMJ Open 2022; 12:e061186. [PMID: 35534068 PMCID: PMC9086622 DOI: 10.1136/bmjopen-2022-061186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse the relation between the used labour pain relief and childbirth experience measured by Visual Analogue Scale (VAS). DESIGN A retrospective cohort study. SETTING Childbirth in five Helsinki University Hospital delivery units from 2012 to 2018. PRIMARY OUTCOME MEASURE Childbirth experience measured by VAS and classified in three groups (negative VAS=1-5, positive VAS=6-8 and highly positive=9-10). RESULTS The use of epidural or non-epidural compared with non-medical pain relief methods decreased the likelihood to experience highly positive childbirth for primiparous (adjusted OR (aOR)EPIDURAL=0.64, 95% CI 0.57 to 0.73; and aORNON-EPIDURAL=0.76, 95% CI 0.66 to 0.87) and multiparous (aOREPIDURAL=0.90, 95% CI 0.84 to 0.97 and aORNON-EPIDURAL=0.80, 95% CI 0.74 to 0.86) parturients. The effects of epidural differed between primiparas and multiparas. In multiparas epidural was associated with decreased odds for experiencing negative childbirth compared with the non-medical group (aOR=0.70, 95% CI 0.57 to 0.87), while the effect of epidural was considered insignificant in primiparas (aOR=1.28, 95% CI 0.93 to 1.77). CONCLUSION While the use of medical-epidural and non-epidural-pain relief methods were not associated with odds for experiencing negative childbirth in primiparas, using epidural helps to avoid negative experience in multiparas. However, the odds for experiencing highly positive childbirth were decreased if the parturients used any medical pain relief for both primiparas and multiparas. Consequently, the effect of pain relief on the childbirth experience is strongly confounded by indication. Thus, the use of pain relief per se plays a limited role in the complex formation of the overall childbirth experience.
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Affiliation(s)
- Johanna Joensuu
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Hannu Saarijärvi
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Mika Gissler
- Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Tomi Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
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Shen YH, Yang F, Jin LD, Qian YJ, Xing L, Huang YL, Lin SF, Xiao F. Prophylactic Phenylephrine Increases the Dose Requirement of Oxytocin to Treat Uterine Atony During Cesarean Delivery: A Double-Blinded, Single-Center, Randomized and Placebo-Controlled Trial. Front Pharmacol 2021; 12:720906. [PMID: 34744714 PMCID: PMC8563700 DOI: 10.3389/fphar.2021.720906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia. Methods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery. Results: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22). Conclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings.
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Affiliation(s)
- Yao-Hua Shen
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Fan Yang
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Dan Jin
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Yu-Jia Qian
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Li Xing
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Ya-Li Huang
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Su-Feng Lin
- Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Fei Xiao
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
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Chen YH, Chou WH, Yie JC, Teng HC, Wu YL, Wu CY. Influence of Catheter-Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial. J Pers Med 2021; 11:jpm11111099. [PMID: 34834451 PMCID: PMC8619661 DOI: 10.3390/jpm11111099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter–incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p < 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.
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Affiliation(s)
- Ying-Hsi Chen
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Wei-Han Chou
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Jr-Chi Yie
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Hsiao-Chun Teng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Yi-Luen Wu
- Department of Medical Education, National Taiwan University, Taipei 100, Taiwan;
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
- Correspondence: ; Tel.: +886-2-2356-2158; Fax: +886-2-2341-5736
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Alshabibi M, Madkhali AM, Alkinani AA, Alyami AA, Alatassi A. The trends of obstetric anesthesia practice: In a tertiary care center in the Kingdom of Saudi Arabia. Saudi J Anaesth 2021; 15:383-386. [PMID: 34658723 PMCID: PMC8477770 DOI: 10.4103/sja.sja_83_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Obstetric anesthesia provides several methods for the analgesia of labor pain. The neuraxial technique is considered the standard of care for parturient women. The epidural block is widely used in vaginal delivery while the spinal block is the preferred method for cesarean section (C-section). We aim to know the practice of obstetric anesthesia in our center. Methods: A retrospective cross-sectional study was conducted at a tertiary center in Riyadh, Saudi Arabia. The data of all delivery cases from 1/7/2019 to 30/9/2019 were reviewed. Results: We identified a total of 2,140 cases during the 3 months, vaginal delivery was the most common with 72.4% (1550) while the C-section cases were 27.6% (590). Regarding the type of analgesia/anesthesia for vaginal deliveries, intramuscular analgesia was the commonest group with 34.8% (540), followed by the group of ladies who did not receive any analgesia/anesthesia with 31.9% (495), thirdly was epidural cases with 31.8% (493), and the fourth type was spinal 0.6% (10). Regarding C-section, the emergency cases were 65.4% (386). The types of anesthesia for all C-sections were as follows spinal 63.5% (375), GA 23.8% (141), and epidural 12% (74). Regarding anesthesia for elective cases, spinal was 85% (174), GA 14% (28), and epidural 1% (2). Regarding anesthesia for emergency cases, spinal was 52% (201), GA 29% (113), and epidural 19% (72). Conclusions: The use of epidural was low, and the spinal use was relatively on par if we compare with leading western countries. More focused studies and multicenter studies are needed in the country.
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Affiliation(s)
- Mohammed Alshabibi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Azza M Madkhali
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amer A Alkinani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali A Alyami
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaleem Alatassi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia
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7
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Xiao F, Xu WP, Yao HQ, Fan JM, Chen XZ. A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery. Front Pharmacol 2021; 12:608198. [PMID: 34054513 PMCID: PMC8149763 DOI: 10.3389/fphar.2021.608198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Prophylactic infusion of a vasopressor is preferred as a rational choice in clinical practice in Cesarean delivery. Metaraminol is one of most common vasopressors used in obstetric clinical practice. However, the dose-response of metaraminol has not been fully determined and the optimal infusion dose is unknown. Therefore, this study aimed to determine the median effective dose (ED50) and 90% effective dose (ED90) of weight-based fixed-rate metaraminol infusions for preventing spinal-anesthesia-induced hypotension in patients having combined spinal-epidural anesthesia for elective Caesarean delivery. Methods: One hundred and seventeen patients with singleton pregnancies were enrolled and randomly allocated into one of five groups in this study. Patients received prophylactic metaraminol infusion at a fixed rate of 0, 0.25, 1.0, 1.75 or 2.5 μg/kg/min in each group immediately after induction with intrathecal 10 mg of hyperbaric bupivacaine mixed with 5 μg of sufentanil. An effective prophylactic dose was defined as no occurrence of hypotension during the period of spinal introduction and neonatal delivery. Values for ED50 and ED90 of prophylactic infusion of metaraminol were calculated using probit regression. Characteristics of spinal anesthesia and side effects were recorded. Results: The ED50 and ED90 values of weight-based fixed rate of metaraminol infusion were 0.64 (95% CI, 0.04–1.00) μg/kg/min and 2.00 (95% CI, 1.58–2.95) μg/kg/min respectively. The incidence of hypotension decreased with an increased infusion rate of metaraminol in the five groups (test for trend, p < 0.001). The incidence of hypotension was similar between group 0 and 0.25, but significant higher than other groups; the incidence of hypotension was also similar between group 1.0 and 1.75, but higher than group 2.5. The incidence of reactive hypertension was significantly higher in group 2.5 compared to the other groups. Physician interventions were more frequent in group 0, 0.25 and 2.5 than in group 1.0 and 1.75 (adjusted p < 0.001). No difference was found in neonatal outcomes, including Apgar score and pH value of the umbilical artery. Conclusion: In summary, we have compared four different prophylactic weight-based infusion doses of metaraminol for preventing post-spinal hypotension in Cesarean delivery. The ED50 and ED90 values of metaraminol infusion for preventing spinal anesthesia-induced hypotension were 0.64 μg/kg/min and 2.00 μg/kg/min, respectively. This finding may be helpful for guiding clinical practice and further research.
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Affiliation(s)
- Fei Xiao
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Wen-Ping Xu
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Han-Qing Yao
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Jia-Ming Fan
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Xin-Zhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wang H, Gao Q, Xu R, Dong W, Zhang Y, Fan J. The efficacy of ropivacaine and bupivacaine in the caesarean section and the effect on the vital signs and the hemodynamics of the lying-in women. Saudi J Biol Sci 2019; 26:1991-1994. [PMID: 31889783 PMCID: PMC6923449 DOI: 10.1016/j.sjbs.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of ropivacaine and bupivacaine in caesarean section and vital signs and the hemodynamics of the lying-in women. METHODS A total of 480 lying-in women who were admitted to this hospital for treatment between December 2017 and June 2018 were enrolled into this study as the subjects, which were divided into the experiment group and the control group, with 240 subjects in each group. In the experiment group, subjects received the local anesthesia by infusion of 1.5 mL ropivacaine (0.75%), while those in the control group also took the local anesthesia by infusion of 1.5 mL bupivacaine (0.75%). Thereafter, we observed the differences in the anesthetic efficiency, vital signs and hemodynamics of the lying-in women between two groups. RESULTS The excellent and good rates of the anesthesia in two groups were 92.1% and 87.9%, showing no obvious difference; in the experiment group, the average arterial pressures and systolic pressures at 5 min and 10 min after combined spinal and epidural analgesia (CSEA) were all elevated when comparing to the control group (all P < 0.05); in the experiment group, the onset time was obviously extended, while duration of sensory and motor block and the duration of motor block were all shorter than those in the control group (all P < 0.05). During anesthesia, the incidence rate of the adverse reactions in the control group was 2.50%, significantly higher than 0.83% in the experiment group (P < 0.05). CONCLUSION Despite that ropivacaine and bupivacaine are efficient in anesthesia in the CSEA in the caesarean section, ropivacaine is more recommended for little influence on the hemodynamics, shorter duration of sensory block and motor block and low incidence rate of adverse reactions, which are conducive to the recovery and also safe to the patients.
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Affiliation(s)
- Huaizhao Wang
- Department of Anesthesiology, Qingdao Huangdao District Central Hospital, Qingdao 266400, China
| | - Qinghua Gao
- Department of Anesthesiology, Qingdao Huangdao District Central Hospital, Qingdao 266400, China
| | - Ruixue Xu
- Department of Anesthesiology, Qingdao Huangdao District Central Hospital, Qingdao 266400, China
| | - Wei Dong
- Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Yanan Zhang
- Department of Anesthesiology, Qingdao Huangdao District Central Hospital, Qingdao 266400, China
| | - Jinxin Fan
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao 266011, China
- Corresponding author.
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De Viti D, Malvasi A, Busardò F, Beck R, Zaami S, Marinelli E. Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E658. [PMID: 31569595 PMCID: PMC6843194 DOI: 10.3390/medicina55100658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms "cardiomyopathy", "ischaemic heart disease", "arrhythmias", "hypertension", "peripartum period", "diabetes", "advanced maternal age" "anesthesia", "maternal morbidity and mortality" and "litigation". Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.
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Affiliation(s)
- Daniele De Viti
- Department of Cardiology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Francesco Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, 60120 Ancona, Italy.
| | - Renata Beck
- Department of Anesthesia and Analgesia, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
| | - Enrico Marinelli
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
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10
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Liu X, Zhang X, Wang X, Wang J, Wang H. Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis. J Int Med Res 2019; 47:2785-2799. [PMID: 31204535 PMCID: PMC6683877 DOI: 10.1177/0300060518797000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use. Methods Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects. Results The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus. Conclusion Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.
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Affiliation(s)
- Xin Liu
- 1 Department of Anesthesiology, Hanchuan City People's Hospital, Hanchuan, Hubei Province, China
| | - Xiongjie Zhang
- 2 Department of General Surgery II, Hanchuan City People's Hospital, Hanchuan, Hubei Province, China
| | - Xujian Wang
- 3 Department of Anesthesiology, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong Province, China
| | - Jinyan Wang
- 3 Department of Anesthesiology, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong Province, China
| | - Hao Wang
- 3 Department of Anesthesiology, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong Province, China
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Liu L, Qian J, Shen B, Xiao F, Shen H. Intrathecal dexmedetomidine can decrease the 95% effective dose of bupivacaine in spinal anesthesia for cesarean section: A prospective, double-blinded, randomized study. Medicine (Baltimore) 2019; 98:e14666. [PMID: 30817591 PMCID: PMC6831281 DOI: 10.1097/md.0000000000014666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dexmedetomidine (Dex), as an adjuvant, has been reported to prolong the duration of spinal analgesia when adding to local anesthetic. We hypothesized that Dex could enhance the efficiency of intrathecal bupivacaine for spinal anesthesia in cesarean section. The aim of his study is to test our hypothesis that 5 μg Dex could enhance the efficiency of intrathecal bupivacaine and reduce the dose requirement of spinal bupivacaine for patients undergoing cesarean section. METHODS Ninety patients with ASA I or II, who underwent cesarean section, were randomized into 2 groups: group D (bupivacaine + 5 μg Dex) and group C (bupivacaine + the same volume of saline). The subsequent dose of spinal bupivacaine was determined by the improved up-down allocation method. The initial dose of bupivacaine in the 2 groups was 4 mg, and the subsequent dose for the following patient was depended on the probability of the current dose. ED95 of spinal bupivacaine was calculated using logistic regression model. RESULTS The ED95 and 95% confidence intervals (95% CI) of spinal hyperbaric bupivacaine in group D and group C were 7.4 mg (95% CI, 5.6-12.4 mg) and 11.0 mg (95% CI, 4.4-56.8 mg), respectively. The duration of sensory block was 120.5 ± 37.0 minutes in Dex group and 70.5 ± 34.5 minutes in Control group, respectively (P < .05). The duration of analgesia was 230.5 ± 40.5 minutes in Dex group and 145.1 ± 28.5 minutes in Control group, respectively (P < .001). The consumption of postoperative rescued sufentanil was significantly lower in Dex group than in the Control group (56.3 ± 9.4 vs 65.9 ± 10.7 μg). There was not significantly different in the patient satisfaction of analgesia, incidence of side effects, neonatal outcomes and neurological deficit between the 2 groups. CONCLUSION Intrathecal 5 μg Dex enhances the efficacy of spinal bupivacaine by 24% in patients undergoing cesarean section with spinal anesthesia. No additional side effect was observed by adding spinal Dex.
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Affiliation(s)
| | | | | | | | - Huaxiang Shen
- Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, China
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12
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Rodríguez-Campoó MB, Curto A, González M, Aldecoa C. Patient intermittent epidural boluses (PIEB) plus very low continuous epidural infusion (CEI) versus patient-controlled epidural analgesia (PCEA) plus continuous epidural infusion (CEI) in primiparous labour: a randomized trial. J Clin Monit Comput 2018; 33:879-885. [PMID: 30506299 DOI: 10.1007/s10877-018-0229-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
Epidural maintenance technique for labour analgesia updates constantly. Thanks to infusion pumps, the recently developed programmed intermittent epidural bolus (PIEB) may reduce the use of anesthetic drugs and minimize unintended consequences such as cardio or neurotoxicity. Nevertheless, it is not yet a general practice. So far, there are no comparative studies in the literature that address levobupivacaine-based CEI + PCEA versus CEI + PIEB + PCEA. A randomized double-blind trial was carried out to evaluate if PIEB could reduce local anesthetic use compare to PCEA. Primiparous pregnant patients were divided into two groups: PIEB group (continuous infusion plus intermittent automatic doses) and PCEA group (continuous infusion plus PCEA). The primary objective was to analyze the differences between both groups regarding levobupivacaine total dose. The secondary objectives were to find out the differences concerning pain control, motor blockage, satisfaction score, labour time and delivery outcomes. Statistical analyses were done by protocol. The study recruited 200 patients (103 PIEB, 97 PCEA). The total dose administered was significantly higher in PIEB group: PCEA group 52.97 mg, IC 95% 45.65-60.28 mg and PIEB group 62.04 mg, IC 95% 55.46-68.61 mg (p = 0.021). PIEB group required fewer top up boluses (median value1; range 0-2) than CEI + PCEA group (median value 6; range 3-9) p < 0.05. Satisfaction scores were higher in PIEB group (p = 0.039, CI 95% 1.23-1.42). CEI + PIEB was found to be a good alternative to CEI + PCEA with very high rates of satisfaction in both groups although it was higher in PIEB group. PIEB group required fewer PCEA boluses. Further studies are needed to determine the best approach for epidural pain management.Clinical Trial Number and Registry URL: NCT03133091 ( https://clinicaltrials.gov/ct2/show/NCT03133091?term=MB+Rodriguez&rank=1) .
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Affiliation(s)
- Maria Belen Rodríguez-Campoó
- Department of Anesthesia and Surgical Critical Care, Hospital Universitario Rio Hortega (HURH), C/Dulzaina 2, 47012, Valladolid, Spain
| | - Antonio Curto
- Department of Anesthesia and Surgical Critical Care, Hospital Universitario Rio Hortega (HURH), C/Dulzaina 2, 47012, Valladolid, Spain
| | - Manuel González
- Research Unit. Hospital Universitario Rio Hortega (HURH), C/Dulzaina2, 47012, Valladolid, Spain
| | - Cesar Aldecoa
- Department of Anesthesia and Surgical Critical Care, Hospital Universitario Rio Hortega (HURH), C/Dulzaina 2, 47012, Valladolid, Spain.
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Zhang YF, Xiao F, Xu WP, Liu L. Prophylactic infusion of phenylephrine increases the median effective dose of intrathecal hyperbaric bupivacaine in cesarean section: A prospective randomized study. Medicine (Baltimore) 2018; 97:e11833. [PMID: 30095659 PMCID: PMC6133454 DOI: 10.1097/md.0000000000011833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Phenylephrine infusion to prevent spinal-induced hypotension can attenuate cephalic spread of intrathecal bupivacaine. Therefore, we suspected the intrathecal dose requirement for bupivacaine may differ when using phenylephrine infusion to prevent spinal-induced hypotension in cesarean section. We designed a prospective, randomized study to determine the ED50 of hyperbaric bupivacaine for cesarean section under combined spinal-epidural anesthesia in healthy parturients with and without prophylactic phenylephrine infusion to prevent spinal-induced hypotension. METHODS Sixty healthy parturients rated American Society for Anesthesiology status I/II undergoing elective cesarean section were enrolled in this study, which was conducted July 2016 to February 2017 in the labor and delivery department of Jiaxing University Affiliated Women and Children Hospital. After enrollment, patients were randomized into 2 groups of 30 by blinded opaque envelopes sorted by computer-generated random allocation. Solutions were prepared by an anesthesiologist not involved in outcome measurement. Patients and anesthesiologists collecting data were blinded to group allocation. Group P (phenylephrine group) parturients received prophylactic infusion of phenylephrine at the time of intrathecal injection. Group S (saline group) parturients receive the same volume of saline. Doses of intrathecal bupivacaine for each patient were determined using an up-down allocation method; initial dose was 7 mg. Effective dose was defined as bilateral T6 or above sensory block level achieved within 10 minutes of intrathecal drug administration and no additional epidural lidocaine required for intraoperative pain. The Dixon and Massey formula was used to calculate ED50 values. RESULTS The ED50 values for hyperbaric bupivacaine were 7.0 mg (95% confidence interval [CI]: 6.6-7.4 mg) and 4.9 mg (95% CI: 4.4-5.4 mg) for groups P and S, respectively (P < .001). There were significant differences in incidence of hypotension and pH of umbilical arterial blood between groups S and P (60% vs 10%, P = .04 and 7.31 ± 0.04 vs 7.28 ± 0.06, P = .003, respectively). CONCLUSION The ED50 of intrathecal hyperbaric bupivacaine is higher when phenylephrine infusion is used to prevent spinal-induced hypotension than when it is not used.
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Xia F, Chang X, Zhang Y, Wang L, Xiao F. The effect of intrathecal dexmedetomidine on the dose requirement of hyperbaric bupivacaine in spinal anaesthesia for caesarean section: a prospective, double-blinded, randomized study. BMC Anesthesiol 2018; 18:74. [PMID: 29935528 PMCID: PMC6015661 DOI: 10.1186/s12871-018-0528-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies have shown that dexmedetomidine (Dex) can prolong the duration of analgesia when added to local anaesthetic as an adjuvant in a central or peripheral nerve block. We hypothesized that intrathecal Dex can reduce the ED95 of spinal hyperbaric bupivacaine. Therefore, we conducted this prospective, double-blinded, randomized study to verify our hypothesis. Methods Ninety patients were allocated into the Dexmedetomidine group (received bupivacaine + 5 mcg dexmedetomidine) and the Control group (received bupivacaine + the same volume of saline) using a double-blinded and randomized method. The first patient in each group received 5 mg of IT hyperbaric bupivacaine, and the next dose for the following patient was determined by the probability of successful anaesthesia of the previous neighbouring dose. An improved up-down sequence allocated method combined with probit analysis was used to determine the ED95 of intrathecal hyperbaric bupivacaine for the two groups. Results The ED95 and 95% confidence intervals (95% CI) of IT hyperbaric bupivacaine of the Dex group and Control group were 8.4 mg (95% CI, 6.5~ 13.8 mg) and 12.1 mg (95% CI, 8.3~ 312.8 mg), respectively. The duration of sensory block was longer in the Dex group than in the Control group (110.3 ± 35.3 vs 67.5 ± 26.2). The duration of analgesia was also longer in the Dex group than in the Control group (224.9 ± 45.4 vs 155.1 ± 31.6). The consumption of postoperative rescued sufentanil was significantly higher in the Control group than in the Dex group. Conclusion Intrathecal 5 mcg dexmedetomidine potentiated hyperbaric bupivacaine antinociception by 31% in spinal anaesthesia for patients undergoing caesarean section. Trial registration We registered this study in a Chinese Clinical Trial Registry (ChiCTR) centre on Nov 1st 2016 and received the registration number: ChiCTR-IPR-16009699.
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Affiliation(s)
- Feng Xia
- Department of Anaesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Xiangyang Chang
- Department of Anaesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Yinfa Zhang
- Department of Anaesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China
| | - Lizhong Wang
- Department of Anaesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China.
| | - Fei Xiao
- Department of Anaesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, Zhejiang, China.
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Razum O, Reiss K, Breckenkamp J, Kaufner L, Brenne S, Bozorgmehr K, Borde T, David M. Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open 2017; 7:e015913. [PMID: 28827247 PMCID: PMC5629712 DOI: 10.1136/bmjopen-2017-015913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). DESIGN Cross-sectional study. SETTING Three obstetric hospitals in Berlin, Germany. METHODS Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. RESULTS The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). CONCLUSIONS We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).
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Affiliation(s)
- Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Katharina Reiss
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
- Healthy Start - Young Family Network, Federal Centre for Nutrition at Federal Office for Agriculture and Food, Bonn, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Lutz Kaufner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Brenne
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Alice Salomon Hochschule Berlin, Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, Berlin, Germany
| | - Matthias David
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Xiao F, Xu W, Feng Y, Fu F, Zhang X, Zhang Y, Wang L, Chen X. Intrathecal magnesium sulfate does not reduce the ED 50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method. BMC Anesthesiol 2017; 17:8. [PMID: 28095795 PMCID: PMC5240204 DOI: 10.1186/s12871-017-0300-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/02/2017] [Indexed: 01/27/2023] Open
Abstract
Background Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery. Methods Sixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T5 sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED50 for both groups was calculated using the Dixon and Massey formula. Results There was no significant difference in the ED50 of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group. Conclusions Intrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects. Trial registration This study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC-14004954.
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Affiliation(s)
- Fei Xiao
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Wenping Xu
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Ying Feng
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Fu
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaomin Zhang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Yinfa Zhang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Lizhong Wang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Xiao F, Xu WP, Zhang YF, Liu L, Liu X, Wang LZ. The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus. Chin Med J (Engl) 2016; 128:2577-82. [PMID: 26415793 PMCID: PMC4736859 DOI: 10.4103/0366-6999.166036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery. This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia. Methods: Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized, double-blinded, dose-ranging study. Patients received 6, 8, 10, 12, or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil. Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation. The 50% effective dose (ED50) and 95% effective dose (ED95) were calculated with a logistic regression model. Results: ED50 and ED95 of intrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA) were 8.28 mg (95% confidence interval [CI]: 2.28–9.83 mg) and 12.24 mg (95% CI: 10.53–21.88 mg), respectively. Conclusion: When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery, the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg, respectively. In addition, this local anesthetic is unsuitable for emergent cesarean delivery, but it has advantages for ambulatory patients.
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Affiliation(s)
| | | | | | | | | | - Li-Zhong Wang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital; Jiaxing Genetic and Reproductive Medicine Research Institute, Jiaxing, Zhejiang 314050, China
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An Update on Maternal Hydration Strategies for Amniotic Fluid Improvement in Isolated Oligohydramnios and Normohydramnios: Evidence from a Systematic Review of Literature and Meta-Analysis. PLoS One 2015; 10:e0144334. [PMID: 26658482 PMCID: PMC4684238 DOI: 10.1371/journal.pone.0144334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/11/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routine-clinical-practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH-therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes. MATERIALS AND METHODS A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (<2000 versus >2000), duration of hydration therapy: (1 day, >1 day but <1 week, >1 week), type of fluid administered (isotonic versus hypotonic versus combination). RESULTS In isolated-oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonic-fluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH. CONCLUSIONS Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH-therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).
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Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:489-95. [PMID: 26249251 PMCID: PMC4555060 DOI: 10.3238/arztebl.2015.0489] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined. METHODS This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF). RESULTS The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies. CONCLUSION Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
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Affiliation(s)
- Ioannis Mylonas
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
| | - Klaus Friese
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
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Lee MH, Kim EM, Bae JH, Park SH, Chung MH, Choi YR, Choi EM. Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section. Yonsei Med J 2015; 56:1122-7. [PMID: 26069138 PMCID: PMC4479843 DOI: 10.3349/ymj.2015.56.4.1122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to determine whether head elevation during combined spinal-epidural anesthesia (CSE) and Caesarean section provided improved hemodynamics and appropriate sensory block height. MATERIALS AND METHODS Forty-four parous women undergoing CSE for elective Caesarean section were randomly assigned to one of two groups: right lateral (group L) or right lateral and head elevated (group HE) position, for insertion of the block. Patients were positioned in the supine wedged position (group L) or the left lateral and head elevated position (group HE) until a block height of T5 to light touch was reached. Group HE was then turned to the supine wedged position with maintenance of head elevation until the end of surgery. Hemodynamics, including the incidence of hypotension, ephedrine dose required, and characteristics of the sensory blocks were analyzed. RESULTS The incidence of hypotension (16 versus 7, p=0.0035) and the required dose of ephedrine [24 (0-40) versus 0 (0-20), p<0.0001] were greater in group L compared to group HE. In group L, the time to achieve maximal sensory block level (MSBL) was shorter (11.8±5.4 min versus 20.1±6.3 min, p<0.0001) and MSBL was also higher than in group HE [14 (T2) versus 12 (T4), p=0.0015]. CONCLUSION Head elevation during CSE and Caesarean section is superior to positioning without head elevation in the lateral to supine position, as it is associated with a more gradual onset, appropriate block height, and improved hemodynamics.
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Affiliation(s)
- Mi Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Mi Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun Hyeon Bae
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Ho Park
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Mi Hwa Chung
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Ryong Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Mi Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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Gizzo S, Andrisani A, Noventa M, Di Gangi S, Quaranta M, Cosmi E, D’Antona D, Nardelli GB, Ambrosini G. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review. PLoS One 2015; 10:e0114190. [PMID: 25646621 PMCID: PMC4315586 DOI: 10.1371/journal.pone.0114190] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/05/2014] [Indexed: 02/06/2023] Open
Abstract
The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.
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Affiliation(s)
- Salvatore Gizzo
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Marco Noventa
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Stefania Di Gangi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Erich Cosmi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Donato D’Antona
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Guido Ambrosini
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
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Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:638093. [PMID: 24955365 PMCID: PMC4052104 DOI: 10.1155/2014/638093] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.
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