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Romero-Gallardo L, Roldan Reoyo O, Castro-Piñero J, May LE, Ocón-Hernández O, Mottola MF, Aparicio VA, Soriano-Maldonado A. Assessment of physical fitness during pregnancy: validity and reliability of fitness tests, and relationship with maternal and neonatal health - a systematic review. BMJ Open Sport Exerc Med 2022; 8:e001318. [PMID: 36172399 PMCID: PMC9511659 DOI: 10.1136/bmjsem-2022-001318] [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] [Accepted: 08/02/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To systematically review studies evaluating one or more components of physical fitness (PF) in pregnant women, to answer two research questions: (1) What tests have been employed to assess PF in pregnant women? and (2) What is the validity and reliability of these tests and their relationship with maternal and neonatal health? Design A systematic review. Data sources PubMed and Web of Science. Eligibility criteria Original English or Spanish full-text articles in a group of healthy pregnant women which at least one component of PF was assessed (field based or laboratory tests). Results A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (ie, 52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6) or the relationship of PF with maternal and neonatal health (n=16). Conclusion Physical fitness has been assessed through a wide variety of protocols, mostly lacking validity and reliability data, and no consensus exists on the most suitable fitness tests to be performed during pregnancy. PROSPERO registration number CRD42018117554.
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Affiliation(s)
- Lidia Romero-Gallardo
- Department of Physical Education and Sport, Universidad de Granada, Granada, Spain.,Sport and Health University Research Centre, Universidad de Granada, Granada, Spain
| | - Olga Roldan Reoyo
- Applied Sports Technology Exercise and Medicine Research Centre, Swansea University, Swansea, UK.,Sport Science Department, Swansea University, Swansea, UK
| | - Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cadiz, Cadiz, Spain.,The Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
| | - Linda E May
- Kinesiology, East Carolina University College of Health and Human Performance, Greenville, North Carolina, USA.,Department of Obstetrics & Gynecology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Olga Ocón-Hernández
- Gynaecology and Obstetrics Unit, 'San Cecilio' University Hospital, Universidad de Granada, Granada, Spain.,The Biosanitary Research Institute of Granada.ibs, Granada, Spain
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Lab, School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Virginia A Aparicio
- Sport and Health University Research Centre, Universidad de Granada, Granada, Spain.,Department of Physiology, Institute of Nutrition and Food Technology and Biomedical Research Centre, Universidad de Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
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Denize KM, Akbari P, da Silva DF, Haman F, Adamo KB. Greater energy demand of exercise during pregnancy does not impact mechanical efficiency. Appl Physiol Nutr Metab 2019; 45:493-499. [PMID: 31614094 DOI: 10.1139/apnm-2019-0450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pregnant women are recommended to engage in 150 min of moderate-intensity physical activity per week to reduce pregnancy complications. Many women struggle to remain physically active throughout pregnancy, and there is no consensus about whether women adopt a less efficient movement pattern as they progress through pregnancy and experience gestational weight gain. This study assessed the change in energy expenditure and mechanical efficiency in pregnant women (PREG; n = 10) when performing a walking treadmill task in early, mid, and late pregnancy and also compared with an age- and body mass index-matched, nonpregnant (CON; n = 10) group. On average, the PREG group gained within the Institute of Medicine's gestational weight gain guidelines (11.6 ± 3.6 kg) and were all inactive (measured using accelerometry), except for 1 participant, by the third trimester, as per the 2019 Canadian physical activity guidelines for pregnant women. Energy expended to complete the walking task increased throughout pregnancy and was higher than the controls (111.5 ± 24.6 kcal) in mid and late pregnancy (139.0 ± 22.2 kcal, p = 0.02, and 147.3 ± 24.6 kcal, p = 0.005, respectively), but not early pregnancy (129.9 ± 18.9 kcal, p = 0.08). Walking mechanical efficiency was similar within pregnant women at each time point and compared to nonpregnant controls. Our findings add to the growing body of evidence demonstrating that pregnant women can safely perform physical activity by showing that walking mechanical efficiency is unchanged at low to moderate intensities. Novelty Energy demand during exercise increases proportionally to weight gain across pregnancy trimesters. However, mechanical efficiency remains unchanged during low- to moderate-intensity walking.
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Affiliation(s)
- Kathryn M Denize
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Pegah Akbari
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Danilo Fernandes da Silva
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Francois Haman
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Hernandez HJ, McIntosh V, Leland A, Harris-Love MO. Progressive Resistance Exercise with Eccentric Loading for the Management of Knee Osteoarthritis. Front Med (Lausanne) 2015; 2:45. [PMID: 26217665 PMCID: PMC4497310 DOI: 10.3389/fmed.2015.00045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/26/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The patient was a 58-year-old African-American male with radiographic evidence of bilateral knee osteoarthritis (OA). He participated in a standardized 12-week eccentric strengthening program within a Veterans Affairs (VA) medical center. BACKGROUND The use of an eccentric training paradigm may prove to be beneficial for older adults with knee OA since eccentric muscle actions are involved in the energy absorption at the knee joint during gait and controlled movement during stair descent. Furthermore, in comparison to standard muscle actions, eccentric muscle actions result in higher torque generation and a lower rate of oxygen consumption at a given level of perceived exertion. Therefore, this mode of progressive resistance exercise may be ideal for older adults. DISCUSSION The patient completed an eccentric strengthening regimen for the knee flexors and extensors twice per week without an exacerbation of knee pain. Muscle morphology measures of the rectus femoris were measured using diagnostic ultrasound. Isokinetic measures of muscle peak torque were obtained at 60°/s and 180°/s. Functional performance was assessed using a physical performance battery and stair-step performance was assessed from the linear displacement of the center of gravity trajectories obtained with a force plate. Visual analog scale pain ratings and self-reported global disease status were also documented. Post-exercise assessments revealed improvements in sonographic muscle size and tissue composition estimates, peak knee extensor torque (ranging from 60 to 253%), functional performance, and global disease status. CONCLUDING REMARKS The patient exhibited improvements in muscle morphology, muscle strength, functional performance, pain, and global disease status after 12 weeks of an eccentric strengthening regimen. The intervention and outcomes featured in this case were feasible to implement within a VA medical center and merit further investigation.
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Affiliation(s)
- Haniel J. Hernandez
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC, USA
| | - Valerie McIntosh
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
| | - Azadeh Leland
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC, USA
| | - Michael O. Harris-Love
- Human Performance Research Unit, Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Anabah T, Olufolabi A, Boyd J, George R. Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1013322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tweed N, Williams S, Williams D, Dingley J. Utility of a low-cost wireless force platform as a potential clinical test of balance recovery after neuraxial anaesthesia. Int J Obstet Anesth 2014; 23:227-32. [DOI: 10.1016/j.ijoa.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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Cakmak B, Inanir A, Nacar MC, Filiz B. The Effect of Maternity Support Belts on Postural Balance in Pregnancy. PM R 2014; 6:624-8. [DOI: 10.1016/j.pmrj.2013.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/19/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Patel NP, El-Wahab N, Fernando R, Wilson S, Robson SC, Columb MO, Lyons GR. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia 2014; 69:458-67. [PMID: 24738803 DOI: 10.1111/anae.12602] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 02/02/2023]
Abstract
We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population.
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Affiliation(s)
- N P Patel
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK
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Evaluation of postural equilibrium and fall risk during pregnancy. Gait Posture 2014; 39:1122-5. [PMID: 24630464 DOI: 10.1016/j.gaitpost.2014.01.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The hormonal, anatomical and physiological states change during pregnancy. Due to these alterations, pregnant women are at increased risk of falling throughout this period. The aim of this study is to evaluate postural equilibrium and risk of falls during pregnancy by comparing dynamic postural stability between pregnant and non-pregnant control women. METHODS Eighty pregnant women (the first, second and third trimester of pregnancy; 25, 30 and 25, respectively) and thirty nonpregnant control women were evaluated and compared in terms of dynamic postural stability using the Biodex Balance System. Overall (OA), anterior-posterior (AP), medial-lateral (ML) stability index and fall risk test (FRT) scores were obtained from the mean scores of the three trials at platform stability of level 8. RESULTS No significant differences for OA, APSI and MLSI were found among the pregnant women in the first and second trimester and nonpregnant control subjects. Overall, anteroposterior and mediolateral index scores were significantly higher in pregnant women in the third trimester than nonpregnant controls (p<0.05). Fall risk test scores of third trimester patients were found to be significantly higher than the first and second trimester and nonpregnant control women (p<0.001). CONCLUSIONS Pregnancy has a negative effect on postural stability. Postural equilibrium decreases during pregnancy, particularly in the third trimester. Using postural stability tests may detect pregnant women with a high fall risk.
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Affiliation(s)
- Brigid Hayden
- Department of Obstetrics and Gynaecology, Bolton Hospital, Bolton
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10
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Abstract
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. Although it is well documented that maternal satisfaction scores are higher with ambulatory epidurals than with other more conventional epidural techniques, the other positive effects, such as shorter labor times, and a reduction in instrumental and cesarean delivery rates, thought to have been associated with ambulatory epidurals, have however been more difficult to prove. SUMMARY Since the earliest 'walking epidural' was described in the early 1990s, there has been much research into finding the ideal regional technique for labor analgesia that provides excellent analgesia with high maternal satisfaction scores while having little adverse effect on obstetric outcome. This review attempts to map the journey of the 'walking epidural' from its earliest form to its more recognizable modern day appearance.
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11
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Dynamic postural stability during advancing pregnancy. J Biomech 2010; 43:2434-9. [DOI: 10.1016/j.jbiomech.2009.09.058] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/21/2009] [Accepted: 09/09/2009] [Indexed: 11/19/2022]
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McCrory JL, Chambers AJ, Daftary A, Redfern MS. Dynamic postural stability in pregnant fallers and non-fallers. BJOG 2010; 117:954-62. [DOI: 10.1111/j.1471-0528.2010.02589.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van de Velde M. Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection. ACTA ACUST UNITED AC 2010; 56:546-61. [PMID: 20112546 DOI: 10.1016/s0034-9356(09)70457-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the present review we outline the state-of-the-art of neuraxial analgesia. As neuraxial analgesia remains the gold standar of analgesia during labor, we review the most recent literature on this topic. The neuraxial analgesia techniques, types of administration, drugs, adjuvants, and adverse effects are investigated from the references. Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by the anesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions.
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Affiliation(s)
- M Van de Velde
- Department of Anesthesiology, University Hospitals Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Abstract
This study explored the functional movement task of stepping up and over an obstacle in individuals with Parkinson's disease to their aged-matched controls. Ten participants with Parkinson's disease and 10 aged matched participants were assessed on the Step Up/Over task completed on a NeuroCom EquiTest long forceplate and analyzed using Group MANOVAs. The results indicate that individuals with Parkinson's disease produce less lifting force and exhibited an increased time to complete the task of stepping up and over an object when compared with their aged matched peers. Considering the substantial risk of falls demonstrated in this population these preliminary finding demonstrate the need for interventions aimed at improving this component of function.
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Balance (perceived and actual) and preferred stance width during pregnancy. Clin Biomech (Bristol, Avon) 2008; 23:468-76. [PMID: 18187242 DOI: 10.1016/j.clinbiomech.2007.11.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/15/2007] [Accepted: 11/19/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pregnant women often remark that their balance degrades during pregnancy; however, it appears that no studies have documented the gravida's perception of her balance nor measured direction-specific changes in balance throughout pregnancy or after delivery. METHODS Thirty women, fifteen pregnant and fifteen non-pregnant controls, were tested monthly and through 6-month postpartum. For each session, perceived degradation in sense of balance, laboratory-based balance measures, stance width, and the number of falls since the previous session were recorded. Laboratory-based balance measures, quantified by direction-specific measures of postural sway, were computed from ten 30s quiet-standing trials on a stationary force platform. Repeated-measures analysis of variance, paired t-tests, and Pearson correlations were use to examine group and time effects. FINDINGS For the pregnant group, perceived balance degradation and stance width were highly correlated (r = 0.94). Both increased during pregnancy (P < or = 0.016) and dropped to near-control levels after delivery (P < or = 0.004). Compared to the control group, pregnant subjects displayed increased sway, especially in the anterior-posterior and radial directions (P < or = 0.039). Anterior-posterior sway measures strongly correlated with perceived balance (0.82 > r > 0.72) and also decreased significantly between the third trimester and postpartum (P < or = 0.029). Interestingly, medial-lateral balance measures varied little during pregnancy, but increased after delivery. Contrary to recent work suggesting fall rates of 25%, only 13% of our subjects (n = 2) fell during pregnancy. INTERPRETATION Perceived degradation in balance during pregnancy was strongly related to increasing postural sway instability in the anterior-posterior direction. Lateral stability was maintained during pregnancy and likely accomplished by increasing stance width.
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Rooks JP. Use of nitrous oxide in midwifery practice--complementary, synergistic, and needed in the United States. J Midwifery Womens Health 2007; 52:186-9. [PMID: 17467584 DOI: 10.1016/j.jmwh.2007.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dyer RA, Hodges O. Informed consent for epidural analgesia in labour. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2007. [DOI: 10.1080/22201173.2007.10872462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Roelants F, Mercier-Fuzier V, Lavand'homme PM. The Effect of a Lidocaine Test Dose on Analgesia and Mobility After an Epidural Combination of Neostigmine and Sufentanil in Early Labor. Anesth Analg 2006; 103:1534-9. [PMID: 17122235 DOI: 10.1213/01.ane.0000244595.03322.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We previously demonstrated the effectiveness of epidural sufentanil and the cholinesterase inhibitor, neostigmine, to initiate selective labor analgesia. Because the traditional lidocaine plus epinephrine test dose (TD) may alter the effect of subsequent epidural drugs, we undertook this investigation to evaluate the impact of a lidocaine TD on analgesia from a combination of epidural neostigmine plus sufentanil administered in early labor. Eighty healthy parturients were randomly allocated to two groups to receive a 3 mL-TD, either lidocaine 2%-epinephrine (1:200,000) or saline-epinephrine (1:200,000), followed 3 min later by epidural neostigmine 500 microg plus sufentanil 10 microg. Pain scores were recorded for 30 min after injection, as was the time elapsed from initial bolus until request for supplemental analgesia. Thirty minutes after injection, adequacy of motor function was evaluated by the parturient's ability to sit, stand up, bend her knees, and walk. Lidocaine TD hastened the onset (5 min vs 15 min) and increased duration (122 +/- 53 min vs 98 +/- 54 min; P = 0.02) of analgesia from epidural neostigmine plus sufentanil bolus. In contrast, the TD did not significantly impair the ability to sit, stand up, or bend the knees. The ability to ambulate, however, was reduced (57% vs 82%; P = 0.04). In conclusion, a traditional lidocaine TD significantly enhances the analgesic effect from the epidural neostigmine plus sufentanil combination, but affects ambulation in early labor.
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Affiliation(s)
- Fabienne Roelants
- Department of Anesthesiology, Université Catholique de Louvain, St. Luc Hospital, Av Hippocrate 10-1821, 1200 Brussels, Belgium
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de la Chapelle A, Carles M, Gleize V, Dellamonica J, Lallia A, Bongain A, Raucoules-Aimé M. Impact of walking epidural analgesia on obstetric outcome of nulliparous women in spontaneous labour. Int J Obstet Anesth 2006; 15:104-8. [PMID: 16434183 DOI: 10.1016/j.ijoa.2005.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND To explore the effects of walking epidural analgesia on obstetric and neonatal outcomes, we performed a case-control study. METHOD Each nulliparous woman receiving walking epidural analgesia using 0.0625% bupivacaine (n = 44) was matched to two nulliparous historical controls receiving 0.125% or 0.25% bupivacaine (n = 88 each) for epidural analgesia while recumbent. RESULTS Maternal and obstetric parameters, fetal status and presentation, and oxytocin use were comparable among groups. Those receiving walking epidural analgesia walked for a mean of 60 min (range: 20-75 min). In the control groups the mean total durations of labour were shorter (58 min in the 0.125% group and 99 min in the 0.25% group, P < 0.05). Significantly fewer walking epidural analgesia cases than controls required instrumental vaginal delivery (P < 0.05). No other differences in obstetric or fetal outcome were observed and no mother fell or stumbled while walking. CONCLUSION Although it was associated with a prolonged first stage of labour, walking epidural analgesia appeared safe for nulliparous women and their babies.
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Affiliation(s)
- A de la Chapelle
- Department of Anaesthesiology, University Hospital Nice, France.
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Abstract
In <25 years, intrathecal administration of opioids (i.e. spinal analgesia) has evolved from an experimental model into an important therapy for obstetric analgesia and anaesthesia. A small dose of opioid delivered into the CSF provides almost immediate relief from labour pain with minimal risks to the mother and fetus. Careful attention, and prompt treatment when needed, can ameliorate the adverse effects of fetal bradycardia, respiratory depression and pruritus. The major limitation of intrathecal opioids for labour analgesia is the short duration of effect: 90-180 minutes under ideal circumstances. To address this problem, and to increase flexibility for anaesthesia as well as analgesia, the combined spinal-epidural (CSE) technique was developed. The CSE technique involves injection of drugs into the CSF and placement of an epidural catheter. An intrathecally administered opioid provides a rapid onset of labour analgesia without motor block or significant haemodynamic perturbation. The epidural catheter allows ongoing administration of medications to maintain labour analgesia and provides a means of delivering anaesthesia for operative delivery. This review will focus on intrathecally administered opioids as used as part of CSE analgesia. Considerable research has focused on the optimum dose of opioids when delivered intrathecally, with or without adjuncts, in the CSE technique. Fentanyl and sufentanil, two of the lipophilic synthetic opioids, have emerged as the most useful. Bupivacaine, a long-acting local anaesthetic, is often added to prolong the duration of analgesia, although this tends to increase the likelihood of motor blockade of the lower extremities. Comparisons of the CSE technique with standard epidural practices have shown that both are effective means of providing analgesia during labour. Controversy revolves around the incidence of fetal bradycardia following CSE and whether this phenomenon increases the rate of operative deliveries. The rapid onset of analgesia with intrathecally administered opioids must be balanced against the added risks of dural puncture and considered in the context of the whole duration of labour. Ultimately, the decision to choose a CSE technique depends on the experience of the anaesthesia provider and the local availability of drugs, equipment and monitoring capabilities.
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Affiliation(s)
- Peter DeBalli
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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