1
|
Lawson J, Amaratunge L, Goh M, Selvaratnam RJ. Perinatal outcomes after regional analgesia during labour. Aust N Z J Obstet Gynaecol 2024; 64:334-340. [PMID: 38348733 DOI: 10.1111/ajo.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/21/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes. AIMS To examine the association between regional analgesia and maternal and neonatal outcomes. MATERIALS AND METHODS A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used. RESULTS There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52-3.67), caesarean section (aOR = 2.30, 95% CI: 2.24-2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3-27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21-1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40-1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65-1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56-1.62). CONCLUSION Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk-benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.
Collapse
Affiliation(s)
- Janna Lawson
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Lahiru Amaratunge
- Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, Victoria, Australia
| | - Melody Goh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Nichols W, Elder R, Lie J, Shelton C. Reusable devices to apply cold sensation in the assessment of regional anaesthesia. BMJ 2024; 385:e079331. [PMID: 38811027 DOI: 10.1136/bmj-2024-079331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
| | - Rebecca Elder
- Manchester University NHS Foundation Trust, Manchester
| | - Jason Lie
- East Lancashire Hospitals NHS Trust, Burnley
| | - Cliff Shelton
- Manchester University NHS Foundation Trust, Manchester
- Lancaster Medical School, Lancaster
| |
Collapse
|
3
|
Chassard D, Langlois-Jacques C, Naaim M, Galetti S, Bouvet L, Coz E, Ecochard R, Portefaix A, Kassai-Koupai B. Anesthesia practices for management of labor pain and cesarean delivery in France (EPIDOL): A cross-sectional survey. Anaesth Crit Care Pain Med 2023; 42:101302. [PMID: 37709198 DOI: 10.1016/j.accpm.2023.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This study aimed to collect obstetric anesthesia practice and patient-reported outcomes as an update to the last French Obstetric Anesthesia survey from 1996. METHODS Maternity units were randomly selected across France and surveyed for 7 consecutive days from February, 2016, to January, 2017. Data was gathered prospectively by questionnaires filled out by patients and anesthesia providers. RESULTS There were 1885 questionnaires received from 56 units, with 379 cesarean delivery (CD) and 1506 vaginal delivery (VD) cases analyzed. The overall neuraxial labor analgesia (NLA) rate was 82.5% (95% CI [82.4-82.6]), with 70.3% (95% CI [71.4-71.6]) receiving automated administration (PCEA/PIEB). NLA was effective throughout labor in 68.2% of cases, however, severe pain was reported by 29.4% of patients. The overall rate of alternative approaches for labor analgesia was 19.5% (95%CI [19.2-19.7]). Obesity (OR 2.8; 95% CI [1.0-7.5], p < 0.04) and delivery in level I units (OR 0.6; 95% CI [0.5-0.9], p < 0.01) were associated with severe pain during VD. Satisfaction was found to be similar in patients delivering with or without NLA. The incidence of pain during CD was similar in scheduled versus non-scheduled CD. Failure of NLA during CD was associated with severe pain (OR 10.0; 95% CI [3.1-31.9], p < 0.01) and dissatisfaction (OR 26.2; 95% CI [3.0-225.1], p < 0.01). CONCLUSION Despite the high NLA rate in France, a significant proportion of women experience severe pain during labor and delivery. This study emphasizes the need for further practice guidelines in obstetric anesthesia to ensure optimal pain management and improve patients' experience during childbirth. CLINICALTRIALS govNCT02853890.
Collapse
Affiliation(s)
- Dominique Chassard
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France.
| | - Carole Langlois-Jacques
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - Marie Naaim
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France
| | - Sonia Galetti
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France
| | - Lionel Bouvet
- Service d'Anesthésie-Réanimation, Hôpital Femme Mère Enfant 59, Boulevard Pinel, F-69677 Bron Cedex, France
| | - Elsa Coz
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - René Ecochard
- Service de Biostatistique des Hospices Civils de Lyon 165, Chemin du Grand Revoyet, Bât 4D, F-69495 Pierre-Bénite, France
| | - Aurélie Portefaix
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France; UMR 5558, Université Claude Bernard Lyon 1, F-69100, France
| | - Behrouz Kassai-Koupai
- INSERM, CIC1407, Hospices Civils de Lyon, Groupement Hospitalier Est, 59 Bvd Pinel, F-69500 Bron, France
| |
Collapse
|
4
|
Tomala S, Savoldelli GL, Pichon I, Haller G. Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study. Int J Obstet Anesth 2023; 56:103925. [PMID: 37832391 DOI: 10.1016/j.ijoa.2023.103925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Post-dural puncture headache (PDPH) occurs in 0.38-6.3% of neuraxial procedures in obstetrics. Epidural blood patch (EBP) is the standard treatment but fails to provide full symptom relief in 4-29% of cases. Knowledge of the risk factors for EBP failure is limited and controversial. This study aimed to identify these risk factors. METHODS We performed a retrospective cohort study using electronic records of 47920 patients who underwent a neuraxial procedure between 2001 and 2018 in a large maternity hospital in Switzerland. The absence of full symptom relief and the need for further treatment was defined as an EBP failure. We performed univariate and multivariate analyses to compare patients with a successful or failed EBP. RESULTS We identified 212 patients requiring an EBP. Of these, 55 (25.9%) had a failed EBP. Signs and symptoms of PDPH did not differ between groups. While needle size and multiple pregnancies were risk factors in the univariate analysis, mostly those related to the performance of the EBP remained significant following adjustment. The risk of failure increased when the epidural space was deeper than 5.5 cm (OR 3.08, 95% CI 1.26 to 7.49) and decreased when the time interval between the initial dural puncture and the EBP was >48 h (OR 0.20, 95% CI 0.05 to 0.83). CONCLUSION Persistence of PDPH following a first EBP is not unusual. Close attention should be given to patients having their EBP performed <48 h following injury and having an epidural space located >5.5 cm depth, as these factors are associated with a failed EBP.
Collapse
Affiliation(s)
- S Tomala
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G L Savoldelli
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - I Pichon
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G Haller
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Health Services Management and Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
| |
Collapse
|
5
|
Nichols W, Nicholls J, Bill V, Shelton C. Temperature changes of CoolSticks during simulated use. Int J Obstet Anesth 2023; 55:103890. [PMID: 37169662 DOI: 10.1016/j.ijoa.2023.103890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Cold sensation is often used to check neuraxial anaesthesia and analgesia. One opportunity to reduce the carbon footprint of anaesthesia is to replace vapo-coolant sprays such as ethyl chloride with a reusable device called the CoolStick, which is cooled in a refrigerator between uses. We designed a study to investigate how long the CoolStick remains at its working temperature, which we defined as <15 °C. METHOD Experiments were undertaken using a thermocouple and digital temperature sensor attached to the CoolStick. We conducted two experiments to assess temperature changes following removal from the refrigerator for 10 min; the first investigated passive re-warming in the ambient theatre environment and the second investigated re-warming in simulated use. In our third experiment, we investigated the time taken to cool the device in the refrigerator, following use. Each experiment was repeated three times. RESULTS In the passive re-warming experiment, the mean CoolStick temperature was 7.3 °C at the start, and 14.3 °C after 10 min. In the simulated use experiment, the mean CoolStick temperature was 7.3 °C at the start, and 18.9 °C at 10 min. In the cooling experiment, the mean CoolStick temperature was 15 °C at the start and 7.6 °C at 40 min. CONCLUSION Our study indicates that it is feasible to use the CoolStick for providing cold sensation in clinical practice. Further study would be required to directly compare the effectiveness of the device to existing methods such as coolant sprays or ice in the clinical setting.
Collapse
Affiliation(s)
- W Nichols
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - J Nicholls
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - V Bill
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK.
| |
Collapse
|
6
|
Lazzari C, Raffaelli R, D'Alessandro R, Simonetto C, Bosco M, Zorzato PC, Uccella S, Taddei F, Franchi M, Garzon S. Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study. Arch Gynecol Obstet 2023; 307:1233-1241. [PMID: 35599249 PMCID: PMC10023596 DOI: 10.1007/s00404-022-06600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal-fetal outcomes. METHODS We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records. RESULTS SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes. CONCLUSIONS SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other.
Collapse
Affiliation(s)
- Cecilia Lazzari
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Roberto D'Alessandro
- Department of Anesthesia and Intensive Care, AOUI Verona, University of Verona, Verona, Italy
| | - Chiara Simonetto
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabrizio Taddei
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| |
Collapse
|
7
|
Labor Analgesia: Can It Be Achieved Without an Epidural? Obstet Gynecol 2023; 141:1-3. [PMID: 36701603 DOI: 10.1097/aog.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
8
|
Epidural Analgesia for Labour: Comparing the Effects of Continuous Epidural Infusion (CEI) and Programmed Intermittent Epidural Bolus (PIEB) on Obstetric Outcomes. Rom J Anaesth Intensive Care 2022; 28:29-35. [PMID: 36846539 PMCID: PMC9949009 DOI: 10.2478/rjaic-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Objective In the last few years there is a trend of transiting from the continuous epidural infusion (CEI) method for epidural analgesia to a new method - programmed intermittent epidural analgesia (PIEB). This change improves the quality of epidural analgesia, thanks to an increased spread of the anaesthetic in the epidural space and higher maternal satisfaction. Nevertheless, we must make sure that such change of method does not lead to worse obstetric and neonatal outcomes. Materials and Methods This is a retrospective observational case control study. We compared several obstetrical outcomes between the CEI and PIEB groups, such as the rates of instrumental delivery, rates of caesarean section, duration of first and second stages of labour well as APGAR scores. We further segmented the subjects and examined them in groups of nulliparous and multiparous parturients. Results 2696 parturients were included in this study: 1387 (51.4%) parturients in the CEI group and 1309 (48.6%) parturients in the PIEB group. No significant difference was found in instrumental or caesarean section delivery rates between groups. This result held even when the groups were differentiated between nulliparous and multiparous. No differences were revealed regarding first and second stage duration or APGAR scores. Conclusion Our study demonstrates transition from the CEI to the PIEB method does not lead to any statistically significant effects on either obstetric or neonatal outcomes.
Collapse
|
9
|
Krawczyk P, Jaśkiewicz R, Huras H, Kołak M. Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice. J Clin Med 2022; 11:jcm11113183. [PMID: 35683567 PMCID: PMC9181341 DOI: 10.3390/jcm11113183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
There are many benefits of neuraxial anesthesia (NA) in the obstetric population. We performed a retrospective analysis of anesthesia provided to obstetric patients in the tertiary care center between 1 January 2014 and 31 December 2020 and the influence of the COVID-19 pandemic on anesthetic practice. A total of 15,930 anesthesia procedures were performed. A total of 2182 (17.52%) cesarean sections (CS) required general anesthesia (GA), including 383 (3.07%) of emergency conversion from NA. NA for CS consisted of 9971 (80.04%) spinal anesthesia (SA) and 304 (2.44%) epidural anesthesia (EPI). We found a decrease in the GA rate for CS in 2020 (11.87% vs. 14.81%; p < 0.001). The conversion rate from NA to GA for CS was 2.39% for SA and 31.38% for EPI. The conversion rate from labor EPI to SA for CS increased in 2020 (3.10% vs. 1.24%; p < 0.001), as well as the SA rate for other obstetric procedures (61.32%; p < 0.001). We report 2670 NA for vaginal delivery, representing 31.13% of all vaginal deliveries. NA constituted the vast majority of obstetric anesthesia. However, we report a relatively high incidence of GA. There was a decrease in GA use in the obstetric population during the pandemic. Further reduction in GA use is possible, including an avoidable conversion from NA to GA.
Collapse
Affiliation(s)
- Paweł Krawczyk
- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kopernika 17, 31-501 Cracow, Poland
- Correspondence:
| | - Remigiusz Jaśkiewicz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Jakubowskiego 2, 30-688 Cracow, Poland;
| | - Hubert Huras
- Department of Obstetrics and Gynecology, Jagiellonian University Medical College, Kopernika 23, 31-501 Cracow, Poland; (H.H.); (M.K.)
| | - Magdalena Kołak
- Department of Obstetrics and Gynecology, Jagiellonian University Medical College, Kopernika 23, 31-501 Cracow, Poland; (H.H.); (M.K.)
| |
Collapse
|