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Wang R, Lu J, Chow KM. Effectiveness of mind-body interventions in labour pain management during normal delivery: A systematic review and meta-analysis. Int J Nurs Stud 2024; 158:104858. [PMID: 39043113 DOI: 10.1016/j.ijnurstu.2024.104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/19/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Labour pain is a common experience among women and poses risks to both the mother and neonate. Mind-body interventions have demonstrated effectiveness in diverse contexts, but their effectiveness in labour pain management remains controversial. OBJECTIVE To identify the effects of each category of mind-body interventions on labour pain management, particularly pain intensity; the use of pharmacological pain relief medications; and the consequent outcomes, including the rate of caesarean section, duration of labour, and fear of childbirth. DESIGN Systematic review and meta-analysis. METHODS A systematic search for related articles was conducted in 10 databases. Randomised controlled trials focusing on the effectiveness of mind-body interventions in labour pain management were included. Two researchers independently conducted methodological quality assessments, data extraction and grading the evidence. Meta-analyses were conducted when studies measured the same outcomes. Standardised mean differences were calculated for continuous variables, whilst risk ratios were calculated for dichotomous variables. All analyses were performed using RevMan version 5.3. RESULTS A total of 25 studies from 24 trials were included, and six categories of mind-body interventions, namely hypnosis, mindfulness, breathing skills, muscle relaxation techniques, guided imagery, and therapeutic touch, were identified. Specifically, hypnosis and mindfulness might be effective in relieving labour pain intensity, with large effect sizes (SMD: -1.45, 95 % confidence interval [CI] -2.34, -0.55, I2 = 91 %; SMD: -1.22, 95 % CI -2.07, -0.37, I2 = 93 %, respectively), but could not reduce the use of epidural analgesia. Mindfulness, in particular, yielded statistically significant reductions in the rate of caesarean section, with a small effect size (RR: 0.46, 95 % CI 0.21, 0.97, I2 = 49 %), and in fear of childbirth, with a medium effect size (SMD: -0.63, 95 % CI -1.09, -0.17, I2 = 65 %). Additionally, all categories of mind-body interventions were associated with a significantly decreased duration of labour compared with the control conditions. CONCLUSIONS Mind-body interventions may have potential benefits in terms of decreasing labour pain intensity, the rate of caesarean section, the duration of labour, and fear of childbirth, with small-to-large effect sizes. Particularly, hypnosis and mindfulness exhibited significant positive effects in terms of relieving labour pain intensity, with large effect sizes. These interventions could serve as complementary or alternative methods for labour pain management in clinical practice. Nevertheless, further rigorous randomised controlled trials are warranted to confirm our results. REGISTRATION CRD42024498600 (PROSPERO, January 15, 2024).
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Affiliation(s)
- Ruohan Wang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jinling Lu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Wiesmann C, Horky A, Hentrich A, Bahlmann F, Louwen F, Al Naimi A. The influence of epidural analgesic techniques on obstetrical outcomes. Arch Gynecol Obstet 2024:10.1007/s00404-024-07591-2. [PMID: 38880792 DOI: 10.1007/s00404-024-07591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The aim of this study is to compare and evaluate the obstetrical differences between three techniques, including the programmed intermittent epidural bolus (PIEB), the patient-controlled epidural analgesia (PCEA), and the continuous epidural analgesia (CEA). METHODS This is a retrospective cohort study that investigates the obstetrical outcomes of 2240 patients who received EA during labor in a tertiary maternal unit over the course of 9 years (2011-2018). The only inclusion criterion was the use of epidural analgesia during childbirth and the only exclusion criteria were multiplets' gestation. Multivariate logistic regression, Kruskal-Wallis test, and the log-rank test were utilized to compare the differences between the three EA techniques in terms of cesarean section rate, the incidence of perineal tears, the use of Oxytocin, the duration of labor, and the incidence of paresthesia. RESULTS Out of the 2240 included deliveries; 1084 utilized PIEB, 1086 PCEA, and 70 CEA techniques. The incidence of Cesarean section was the highest in the CEA group (45.7%) compared to PIEB (24.8%) and PCEA (24.4%) P < 0.001. A significantly shorter duration of labor (vaginal delivery) was observed in the PCEA group (n: 821, 336.7 min) compared to the PIEB group (n: 814, 368.8 min) P < 0.001. There were no statistically significant differences in the incidence of perineal tears, the need of uterotonics, and the incidence of paresthesia. CONCLUSION The results of this study indicate that the PIEB and PCEA techniques are superior to the CEA technique when it comes to analgesia during childbirth. In this study, the PCEA technique seems to be the best-suited technique for childbirth, since it had a significantly shorter duration of labor than the PIEB technique.
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Affiliation(s)
- Christian Wiesmann
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Alex Horky
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany
| | - Anna Hentrich
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Franz Bahlmann
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany
| | - Frank Louwen
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ammar Al Naimi
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany.
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Calineata M, Jennewein L, Neef V, Flinspach AN, Louwen F, Zacharowski K, Raimann FJ. Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study. J Clin Med 2023; 12:5770. [PMID: 37762712 PMCID: PMC10532051 DOI: 10.3390/jcm12185770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. METHODS In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. RESULTS The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005]. CONCLUSIONS LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.
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Affiliation(s)
- Martin Calineata
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Lukas Jennewein
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Armin Niklas Flinspach
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Frank Louwen
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Florian Jürgen Raimann
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Guesine GD, Paschoini MC, Melo GA, Araujo Júnior E, Peixoto AB. Labor analgesia and its impact on the maternal and perinatal outcomes. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230500. [PMID: 37466614 DOI: 10.1590/1806-9282.20230500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)-analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)-analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)-analgesia performed with cervical dilatation ≥9.0 cm. RESULTS Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.
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Affiliation(s)
- Georgeana Debs Guesine
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Marina Carvalho Paschoini
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
| | - Giselle Agreli Melo
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Alberto Borges Peixoto
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
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Jayanth MN, Arumulla SP, Kesana P, Kandukuru KC, Basireddy HR, Peddi S. Preprocedural ultrasonography as an adjunct to landmark technique for identification of epidural space in parturients for labor analgesia. Saudi J Anaesth 2023; 17:18-22. [PMID: 37032694 PMCID: PMC10077778 DOI: 10.4103/sja.sja_141_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Pregnancy-induced softening of tissues and ligaments may increase the false-positive rates when identifying the epidural space in parturients by the landmark technique. To mitigate these problems, Ultrasonography (USG), which has now become the eye of anesthesiologists, can be used as a reliable tool to facilitate more accurate epidural needle placement in parturients. This study was conducted to know the efficacy of USG when compared to the traditional landmark method. Methods After the approval from the institutional ethics committee and CTRI registration, 62 parturients of ASA-2 requesting labor analgesia were randomized into 2 groups of 31 each: Group-L (conventional landmark technique) and Group-U (preprocedural USG done before epidural). In group-U, Tuohy's needle was introduced through the USG predetermined insertion point and epidural space was located using the LOR technique. Results USG increased the success rate of epidural at first attempt from 51.6% in group "L" to 87% in group "U." Fewer needle attempts (P-value - 0.001) were required in group "U" as compared to group "L." No accidental dural puncture in group-U, compared to 2 in group-L. Mean Depth of epidural space (cm) ultrasound depth (UD) = 3.89 ± 0.45 cm and needle depth (ND) = 4.05 ± 0.37 cm. Side effects profile in the ultrasound group was better. Conclusion Preprocedural ultrasonography is a simple safe, accurate tool with less number of attempts to determine the needle insertion site, decrease the incidence of accidental dural punctures, and assess epidural space depth in parturients.
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Affiliation(s)
- Midathala N. Jayanth
- Department of Anaesthesiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Shiny P. Arumulla
- Department of Anaesthesiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Pravallika Kesana
- Department of Anaesthesiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Krishna C. Kandukuru
- Department of Anaesthesiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | | | - Shreevani Peddi
- Department of Anaesthesiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
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Abdominal massage: A review of clinical and experimental studies from 1990 to 2021. Complement Ther Med 2022; 70:102861. [PMID: 35907436 DOI: 10.1016/j.ctim.2022.102861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To systematically review the current state and holistic application of abdominal massage (AM). DESIGN A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved. DATA SOURCES The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar. DATA EXTRACTION AND SYNTHESIS Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy. MAIN RESULTS A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies. CONCLUSION The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.
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Huang CY, Lo SF, Chou SH, Shih CL. Analgesic effects of sterile water injection in the management of low back pain during labor: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 159:642-650. [PMID: 35258095 DOI: 10.1002/ijgo.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sterile water injections (SWIs) as a non-pharmacologic and cost-effective method have been adopted to relieve low back labor pain (LBLP). OBJECTIVE To compare the efficacy of intradermal and subdermal SWIs in the treatment of LBLP. SEARCH STRATEGY Three databases (PubMed, Cochrane Library, and ScienceDirect) were searched to find relevant articles using two terms, "labor" and "sterile water". SELECTION CRITERIA Studies reporting women with LBLP treated by intradermal or subdermal SWIs in the low back area were included. DATA COLLECTION AND ANALYSIS Mean differences with 95% confidence interval (CI) and relative risk with 95% CI were used to estimate VAS score and cesarean section rate, respectively. MAIN RESULTS Except for 10 min, the patients in the intradermal or subdermal SWI group experienced considerable pain reduction compared with the control group for 30-45, 60, and 90 min. Directly comparing intradermal and subdermal SWI groups, the subdermal injection group had significantly better pain relief than the intradermal injection group only at 10 min after treatment. CONCLUSIONS Both intradermal and subdermal SWIs could reduce LBLP at 30-90 min. The subdermal SWI had significantly better LBLP relief than the intradermal injection only at 10 min after treatment.
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Affiliation(s)
- Chueh-Yi Huang
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Sheu-Fang Lo
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Lung Shih
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
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Young B, Onwochei D, Desai N. Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics - a systematic review and meta-analysis with trial sequential analyses. Anaesthesia 2020; 76:818-831. [PMID: 32981051 DOI: 10.1111/anae.15255] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with the assistance of preprocedural ultrasound, in comparison with the landmark palpation method. The bibliographic databases Central, CINAHL, EMBASE, Global Health, MEDLINE, Scopus and Web of Science were searched from inception to 13 February 2020 for randomised controlled trials that included pregnant women having neuraxial procedures with preprocedural ultrasound as the intervention and conventional landmark palpation as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenszel method. In all, 22 trials with 2462 patients were included. Confirmed by trial sequential analysis, preprocedural ultrasound increased the first-pass success rate by a risk ratio (95%CI) of 1.46 (1.16-1.82), p = 0.001 in 13 trials with 1253 patients. No evidence of a difference was found in the total time taken between preprocedural ultrasound and landmark palpation, with a mean difference (95%CI) of 50.1 (-13.7 to 113.94) s, p = 0.12 in eight trials with 709 patients. The quality of evidence was graded as low and very low, respectively, for these co-primary outcomes. Sub-group analysis underlined the increased benefit of preprocedural ultrasound for those in whom the neuraxial procedure was predicted to be difficult. Complications, including postpartum back pain and headache, were decreased with preprocedural ultrasound. The adoption of preprocedural ultrasound for neuraxial procedures in obstetrics is recommended and, in the opinion of the authors, should be considered as a standard of care, in view of its potential to increase efficacy and reduce complications without significant prolongation of the total time required.
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Affiliation(s)
- B Young
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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Zhao B, Qian X, Wang Q, Ou X, Lin B, Song X. The effects of ropivacaine 0.0625% and levobupivacaine 0.0625% on uterine and abdominal muscle electromyographic activity during the second stage of labor. Minerva Anestesiol 2019; 85:854-861. [DOI: 10.23736/s0375-9393.19.13246-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. PLoS One 2019; 14:e0209967. [PMID: 30633755 PMCID: PMC6329494 DOI: 10.1371/journal.pone.0209967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background The failure rate of epidural anesthesia using the loss of resistance technique is 13–23%. Objectives To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery. Study design An open label randomized prospective study. Methods Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation. Catheters in both groups were initially tested with 3 ml of 1% lidocaine and those with any evidence of motor blockade were considered intrathecal. Sensory blockade and an 11 point numerical rating score for pain were assessed 30 minutes after administration of an epidural bolus of 10 ml of 0.22% ropivacaine with fentanyl. Successful epidural analgesia was defined as a decrease of 2 or more in the pain score and a bilateral L1-T10 sensory blockade. Results Thirty-one patients were randomized to each group. The first 20 patients in each group were enrolled in a pilot study and were also included in the final analysis. One patient in the electric stimulation group was excluded owing to dural puncture by the Tuohy needle. One patient in each group demonstrated motor blockade after test dose and were considered failures. The number (% (95% confidence interval)) of successful cases were 29 out of 30 (97% (85, 100%)) in the electric stimulation group and 24 out of 31 (77% (61, 89%)) in the loss of resistance group (P = 0.053). However, analysis of only patients with absence of motor blockade revealed that 29 out of 29 (100% (92, 100%)) patients in the electric stimulation group and 24 of 29 (80% (63, 91%)) patients in the loss of resistance group had adequate analgesia (P = 0.024). Conclusions Although limited by lack of blinding, small study size and inclusion of pilot study data, this study suggests epidural electric stimulation improves the success rate of subsequent labor analgesia.
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Kličan-Jaić K, Roso I, Pešić M, Djaković I, Bilić N. Conducting an epidural analgesia in University Hospital Center "Sisters of Mercy": Croatian experience. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2018. [DOI: 10.23736/s0393-3660.17.03670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang Y, Qin QR, Hui LT. Motor blocks and operative deliveries with ropivacaine and fentanyl for labor epidural analgesia: A meta-analysis. J Obstet Gynaecol Res 2018; 44:2156-2165. [PMID: 30084116 DOI: 10.1111/jog.13772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Yang Zhang
- 2nd Inpatient Department; Binzhou People's Hospital; Binzhou China
| | - Qing-Rong Qin
- School of Nursing, Binzhou Polytechnic College; Binzhou China
| | - Liang-Tu Hui
- 2nd Inpatient Department; Binzhou People's Hospital; Binzhou China
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Djaković I, Sabolović Rudman S, Košec V. Effect of epidural analgesia on mode of delivery. Wien Med Wochenschr 2016; 167:390-394. [DOI: 10.1007/s10354-016-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Rodríguez-Ramón R, Márquez-González H, Jiménez-Báez MV, Iparrea-Ramos IC. Analgesic efficacy of two concentrations of bupivacaine in women in labor: Randomized, controlled, triple blind clinical trial. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rodríguez-Ramón R, Márquez-González H, Jiménez-Báez MV, Iparrea-Ramos IC. Eficacia analgésica entre dos concentraciones de bupivacaína en mujeres en trabajo de parto. Ensayo clínico controlado aleatorizado triple ciego. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Guo S, Li B, Gao C, Tian Y. Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e880. [PMID: 26061307 PMCID: PMC4616487 DOI: 10.1097/md.0000000000000880] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to compare the efficacy and safety of the combinational use of bupivacaine and fentanyl versus ropivacaine and fentanyl in epidural analgesia for labor. Multiple electronic databases were searched by using appropriate MeSH terms, and keywords for original research papers published before October 2014. Meta-analyses were based on mean differences between the groups as well as odds ratios. Statistical heterogeneity was tested by I² index. Fifteen randomized controlled trials, recruiting 2097 parturient mothers overall, were selected for the meta-analyses. Concentrations of the preparations used (weight/volume; mean and standard deviations) were bupivacaine 0.1023% ± 0.0375%, ropivacaine 0.1095% ± 0.042%, and fentanyl 0.00021% ± 0.000089%. There were no statistically significant differences between both the combinations in the mean change in Visual Analog Score for pain during labor, incidence of instrumental or cesarean delivery, neonate Apgar score of <7, maternal satisfaction, duration of either first or second stage of labor, oxytocin use for induction, onset of analgesia, and duration of analgesia. Women who received ropivacaine and fentanyl had significantly lower incidence of motor blocks (odds ratio [95% CI] = 0.38 [0.30, 0.48] P < 0.00001, fixed effect and 0.38 [0.27, 0.54] P < 0.0001, random effects I² 30%) when compared with women who received bupivacaine and fentanyl. Incidence of side effects was similar for both the combinations. Analgesia with ropivacaine in combination with fentanyl at 0.1%:0.0002% ratio for labor pain relief is associated with lower incidence of motor blocks in comparison with analgesia with bupivacaine and fentanyl at similar ratio (0.1%: 0.0002%).
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Affiliation(s)
- Shanbin Guo
- From the Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang (SG); Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan (BL, CG); and Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China (YT)
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Li Y, Hu C, Fan Y, Wang H, Xu H. Epidural analgesia with amide local anesthetics, bupivacaine, and ropivacaine in combination with fentanyl for labor pain relief: a meta-analysis. Med Sci Monit 2015; 21:921-8. [PMID: 25816849 PMCID: PMC4395021 DOI: 10.12659/msm.892276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study compares the effectiveness of bupivacaine and fentanyl (BUPI-FEN) and ropivacaine and fentanyl (ROPI-EFN) in epidural analgesia for labor pain through a meta-analysis of relevant randomized clinical trials. Material/Methods Multiple electronic databases were searched using appropriate MeSH terms and keywords for original English language research papers published between 1990 and March 2014. Meta-analyses results were based on the mean differences between the groups as well as odds ratios where appropriate. Statistical heterogeneity amongst the included studies was tested by I2 index. Results Nine studies that met the inclusion criteria were selected for analysis which consisted of 556 parturient patients. The duration of the second stage of labor was significantly shorter in the BUPI-FEN group by a mean of −6.87 (−10.98, −2.77; P<0.002). On the other hand, the ROPI-FEN group had a significantly lower incidence of motor blockade by a mean of 0.31 (0.18, 0.51; P<0.00001). A positive relationship between the amide local anesthetic concentration and the number of women having motor blockade was observed, but a negative relationship between fentanyl concentration and the number of women experiencing a motor block. Moreover, a positive correlation was found between the concentration of ropivacaine and the incidence of instrumental delivery and between the concentration of bupivacaine and the incidence of cesarean delivery. Conclusions In combination with fentanyl, bupivacaine and ropivacaine exhibit comparable efficacy and safety. However, BUP-FEN analgesia led to a shortened second-stage labor and ROPI-FEN resulted in a significantly lower incidence of motor block.
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Affiliation(s)
- Yiyang Li
- Department of Gynecology, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Cong Hu
- Center of Reproductive Medicine, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yanyan Fan
- Department of Gynecology, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Huixia Wang
- Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan, Shandong, China (mainland)
| | - Hongmei Xu
- Department of Obstetrics, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Li B, Wang H, Gao C. Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis. J Clin Pharmacol 2015; 55:584-91. [PMID: 25535687 DOI: 10.1002/jcph.453] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/18/2014] [Indexed: 01/09/2023]
Abstract
This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI-FEN) and sufentanil (BUPI-SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta-analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I(2) index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI-SUF and BUPI-FEN administered mothers (mean difference [95%CI] of -33.55 [-74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of -0.61 [-1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score < 7 was significantly lower in BUPI-FEN group (odd ratio [95%CI] of 0.31 [0.10, 0.95]; P < .05). Pruritus incidence was similar. In conclusion, BUPI-FEN combination exhibits significantly better tolerability at an approximate ratio of 6 FEN:1 SUF, albeit, both fentanyl and sufentanil in combination with bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.
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Affiliation(s)
- Bo Li
- Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan, China
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Analgesic efficacy of two concentrations of bupivacaine in women in labor: Randomized, controlled, triple blind clinical trial☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543030-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Genc M, Sahin N, Maral J, Celik E, Kar AA, Usar P, Korkut B, Guclu S. Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour? J OBSTET GYNAECOL 2014; 35:672-5. [PMID: 25546524 DOI: 10.3109/01443615.2014.991299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this study we aimed to explore the effects of epidural analgesia achieved by a combination of low-dose bupivacaine and fentanyl infused through an epidural catheter on mother, foetus and labour process in nulliparous at-term pregnant women during vaginal delivery. This study was designed in a prospective, randomised controlled manner. Epidural analgesia was achieved in 50 nulliparous women. Fifty nulliparous women did not undergo epidural analgesia procedure. The duration of the first stage of labour was significantly shortened, while the second stage was significantly lengthened in pregnant women who underwent epidural analgesia (p < 0.05). In conclusion, starting epidural analgesia application during the active phase of the first stage of labour may shorten the duration of the first stage compared with the group of nulliparous women not undergoing epidural analgesia. The factor that has an impact on this may be the addition of fentanyl to bupivacaine used for epidural analgesia.
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Affiliation(s)
- M Genc
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - N Sahin
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - J Maral
- b Department of Anaesthesia and Intensive Care , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - E Celik
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - A A Kar
- b Department of Anaesthesia and Intensive Care , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - P Usar
- b Department of Anaesthesia and Intensive Care , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - B Korkut
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Sifa University , İzmir , Turkey
| | - S Guclu
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Sifa University , İzmir , Turkey
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Lv BS, Wang W, Wang ZQ, Wang XW, Wang JH, Fang F, Mi WD. Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis. Curr Med Res Opin 2014; 30:2279-89. [PMID: 25050590 DOI: 10.1185/03007995.2014.946127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In epidural analgesia, synthetic opioids increase the potency of amide local anesthetics by modifying their analgesic properties. The purpose of this systematic review and meta-analysis is to compare the efficacy and safety of bupivacaine with ropivacaine and levobupivacaine in combination with sufentanil (BUPI-, ROPI-, and LBUPI-SUF respectively) in epidural analgesia for labor. METHODS A literature search was made in multiple electronic databases for original research papers published between 1995 and 2014. Meta-analyses were based on mean differences between the groups as well as odds ratios where appropriate. Both the fixed effects and random effects models were utilized and heterogeneity was tested with the I(2) index. RESULTS Analgesia duration was significantly longer in ROPI-SUF and LBUPI-SUF than in BUPI-SUF administered women with a mean difference (95% CI) of 16.12 (2.56, 29.68); P < 0.03 and 18.02 (9.09, 26.96); P < 0.0001 respectively under a random effects model (REM). Effective analgesia achievement was significantly earlier in the BUPI-SUF than in either the ROPI-SUF (2.61 [1.87, 3.36]; P < 0.00001) or the LBUPI-SUF groups (4.53 [3.66, 5.40]; P < 0.00001) under a fixed effects model (FEM) but not under a REM (I(2 )= 85%). Motor blockade incidence was higher in BUPI-SUF anesthetized patients, although the difference was not statistically significant. A higher incidence of instrumental deliveries was evident in the ROPI-SUF (FEM: 1.68 [1.13, 2.50]; P < 0.02/REM: 1.76 [1.00, 3.11]; P = 0.05) and LBUPI-SUF (FEM: 2.03 [1.07, 3.86]; P < 0.04/REM: 2.03 [1.07, 3.86]; P < 0.04) groups than in the BUPI-SUF group of patients. Inconsistencies in the availability of parametric data and use of slightly varying anesthetic dosages in included studies were important limitations. CONCLUSION Whereas significantly longer labor analgesia can be achieved with ROPI-SUF and LBUPI-SUF and ropivacaine is associated with comparatively less motor blockade, labor duration after epidural analgesia has been found to be shorter in BUPI-SUF and there is a low incidence of instrumental delivery.
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Affiliation(s)
- Bao-Sheng Lv
- Anesthesia and Operation Center, Chinese PLA General Hospital , Beijing , China
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Nassar M, Abdelazim IA. Pre-puncture ultrasound guided epidural insertion before vaginal delivery. J Clin Monit Comput 2014; 29:573-7. [DOI: 10.1007/s10877-014-9634-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022]
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Mauri PA, Contini NNG, Giliberti S, Barretta F, Consonni D, Negri M, Di Benedetto I. Intrapartum Epidural Analgesia and Onset of Lactation: A Prospective Study in an Italian Birth Centre. Matern Child Health J 2014; 19:511-8. [DOI: 10.1007/s10995-014-1532-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Obstetrical epidural and spinal anesthesia in multiple sclerosis. J Neurol 2013; 260:2620-8. [DOI: 10.1007/s00415-013-7035-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/30/2013] [Accepted: 07/04/2013] [Indexed: 11/27/2022]
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López de Hierro CF. [Obstetric anesthesia: a challenge now in our hands]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:3-5. [PMID: 21348210 DOI: 10.1016/s0034-9356(11)70690-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Christiaens W, Verhaeghe M, Bracke P. Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands. BMC Health Serv Res 2010; 10:268. [PMID: 20831798 PMCID: PMC2944275 DOI: 10.1186/1472-6963-10-268] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. METHODS Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. RESULTS Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour. CONCLUSIONS Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.
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Affiliation(s)
| | | | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
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Farid WO, McCallum D, Tait RJ, Dunlop SA, Hulse GK. Minor pathological changes are induced by naltrexone-poly(DL-lactide) implants in pregnant rats. J Biomed Mater Res A 2010; 91:964-74. [PMID: 19097147 DOI: 10.1002/jbm.a.32283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oral naltrexone is used to treat alcohol and heroin dependence but is associated with poor patient compliance. Sustained-release preparations have been developed to overcome noncompliance. Many sustained-release preparations are composed of polymers combined with naltrexone. Limited data indicate that polymers induce variable levels of tissue reactivity and that naltrexone may increase this effect. A slow-release subcutaneous naltrexone-poly (DL-lactide) implant is currently being trialed to treat heroin dependence in Western Australia. A minority of women fall pregnant and, although tissue reactivity in nonpregnant humans is relatively minor, detailed chronological data during pregnancy are lacking. Histological changes in pregnant rats were assessed; a single active tablet containing poly[trans-3,6-dimethyl-1,4-dioxyane-2,5-dione] (DL-lactide) loaded with 25 mg of naltrexone was implanted subcutaneously, and tissue response was compared with inactive polymer implantation. Rats were timed mated at 13-26 days postimplant. Tissue assessment up to 75 days by a pathologist showed that naltrexone induced chronic inflammatory response in a dose-dependent manner, although still at a low level. Furthermore, for inactive implants, minimal foreign body reaction and fibrosis, together with low-level inflammation, suggested good long-term biocompatibility. We conclude that the Australian naltrexone-poly(DL-lactide) implant is tolerated in pregnant rats, reinforcing its potential role for managing alcohol and heroin dependence in pregnant humans.
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Affiliation(s)
- W O Farid
- Experimental and Regenerative Neurosciences, School of Animal Biology (M317), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Hutton EK, Kasperink M, Rutten M, Reitsma A, Wainman B. Sterile water injection for labour pain: a systematic review and meta-analysis of randomised controlled trials. BJOG 2009; 116:1158-66. [PMID: 19459860 DOI: 10.1111/j.1471-0528.2009.02221.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Up to one-third of labouring women will experience painful 'back labour'. Sterile water injected lateral to the lumbosacral spine is a simple and well-researched approach to this pain. OBJECTIVE To determine if sterile water injection for low back pain compared to placebo or alternative therapy increased or decreased the rate of Caesarean section. SEARCH STRATEGY We performed a literature search with no language restriction in four databases: the Cochrane library, EMBASE (1980-2009), Ovid Medline (1950-2009) and CINAHL (1982-2009). SELECTION CRITERIA We included all randomised controlled trials (RCTs) of sterile water injection for labour pain that included outcomes of interest and original data. DATA COLLECTION AND ANALYSIS We compared Caesarean section rates among women who received sterile water injection in labour with those who received either placebo treatment or another non-pharmacological treatment modality. Other outcomes included pain scores, use of regional analgesia and women's assessment of treatment. We used Revman 5 for the meta-analysis. Data were entered by one reviewer and independently cross-checked. Pooled outcomes were reported as Relative Risk (RR) or Weighted Mean Difference using Mantel-Haenszel fixed-effects model except when the I2 value >50% indicated significant heterogeneity in which case random-effects model was used. MAIN RESULTS We included eight RCTs. The Caesarean section rate was 4.6% in the sterile water injection group and 9.9% in the comparison group (n = 828) (RR 0.51, 95% CI: 0.30, 0.87). CONCLUSION We believe that a large RCT should be mounted to validate our findings regarding the impact of sterile water injections on mode of delivery.
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Affiliation(s)
- E K Hutton
- McMaster University, Hamilton, ON, Canada.
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Kukulu K, Demirok H. Effects of Epidural Anesthesia on Labor Progress. Pain Manag Nurs 2008; 9:10-6. [DOI: 10.1016/j.pmn.2007.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 08/07/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
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Tomović B, Čutura N, Soldo V. Experience in application of epidural anesthesia during delivery in the "Narodni front" Gynecology-obstetric Clinic in Belgrade. SCRIPTA MEDICA 2007. [DOI: 10.5937/scrimed0702079x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ros A, Felberbaum R, Jahnke I, Diedrich K, Schmucker P, Hüppe M. Epidural anaesthesia for labour: does it influence the mode of delivery? Arch Gynecol Obstet 2006; 275:269-74. [PMID: 17021773 DOI: 10.1007/s00404-006-0248-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 08/24/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidural anaesthesia (EDA) is an effective method to lower labour pain. EDA might have an impact on instrumental delivery rates and on caesarean section rates. The present study compares the mode of delivery in women who were either receiving EDA or not. The indication for EDA was pain relief only in order to switch off a selection bias. METHODS During a 1-year duration, we included a total of 1,452 cases. Exclusion criteria were factors that could influence the mode of delivery, independent from EDA, as well as obstetrical indications for administering EDA. 530 women remained in the analysis. The primary outcome variable was the mode of delivery. RESULTS We detected in both nullipara and multipara a statistically significant accumulatin in patients with EDA and caesarean section combined. Most importantly, the majority of the women without EDA (57% of nullipara and 60% of multipara) delivered within the median timeframe from admission until administration of EDA. CONCLUSIONS It seems to be obvious to conclude that EDA as performed in our study results in a higher rate of caesarean sections. It is important though to take into consideration that between the period from admission to the delivery ward and administration of EDA most of the parturients without EDA had already delivered. Our results make evident, that the administration of EDA exclusively used for reducing labour pain is a result of a complex collaboration of temporal conditions of labour as well as psychological conditions and also of the mother's wish.
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Affiliation(s)
- Andrea Ros
- Department of Anaesthesiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Fauveau V, de Bernis L. "Good obstetrics" revisited: too many evidence-based practices and devices are not used. Int J Gynaecol Obstet 2006; 94:179-84. [PMID: 16844125 DOI: 10.1016/j.ijgo.2006.05.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 02/02/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION As countries are designing and implementing strategies to address maternal and newborn mortality and morbidity (Millennium Development Goals 5 and 4), it appears that a large number of evidence-based obstetric practices are not used in many settings, and this is a major obstacle to the improvement of quality obstetric care. OBJECTIVES To remind readers of the existing, relatively easy-to-implement, evidence-based interventions that are currently not being universally applied in obstetric care and, second, to foster research to expand the evidence base further for obstetric care practices and devices, especially those that could be used in resource-poor settings. METHODS We review possible reasons why changes into practices are difficult to obtain, and we list the key evidence-based interventions known to effectively deal with the main obstetric complications, with supporting references and sources of documentation. We also list some promising interventions that require more research before being recommended. CONCLUSION Professionals and health services managers have a crucial role in producing the best quality obstetric and neonatal care through implementing the listed evidence-based interventions and make them accessible to all pregnant women and their newborns without delay, even in poor settings. Reasons for which progress is slow should be addressed. One of these reasons being the lack of access to scientific knowledge from the part of professionals in developing countries, we give the key references and also websites which are freely accessible through the Internet. It is hoped that this paper will stimulate the discussion on the dissemination and use of good obstetric practices, and contribute to better maternal and newborn health.
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Affiliation(s)
- V Fauveau
- Technical Support Division, UNFPA Geneva, Switzerland.
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Abstract
Patient-controlled analgesia (PCA) has become the gold standard for acute pain management since it was first introduced 20 years ago, and its merits have been discussed in quite a large number of publications. This review summarizes the more recent developments, such as new application devices and strategies, including intranasal, spinal, and regional PCA; patient-controlled sedation; experience with children and elderly people; and some data from chronic pain situations. Analyzing PCA literature from 2001 onwards confirms the author's long belief that the PCA principle ("WYNIWYG": what you need is what you get) was the most important aspect of a patient-controlled strategy, more or less independent of the type of drug or machine. Discovering this principle has changed the understanding of pain and suffering.
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Affiliation(s)
- Klaus A Lehmann
- Department of Anesthesiology, University of Cologne, Cologne, Germany
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Affiliation(s)
- Robert D'Angelo
- Wake Forest University School Of Medicine, Winston-Salem, NC 27103, USA.
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Braga ADFDA, Braga FSDS, Potério GMB, Pereira RIC, Reis E, Cremonesi E. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003; 20:631-5. [PMID: 12932064 DOI: 10.1017/s0265021503001017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Subarachnoid block is a widely used technique for Caesarean section. Its quality can be improved by adding opioids to the local anaesthetics. We studied the quality of the block and its maternal-fetal repercussions when different doses of sufentanil were combined with hyperbaric bupivacaine using the intrathecal route in pregnant women undergoing Caesarean section. METHODS This was a prospective, randomized, double-blind, controlled trial with 80 pregnant women, ASA I-II, who were scheduled for elective Caesarean section under subarachnoid block. Patients were distributed into four groups according to the dose of sufentanil used: no sufentanil (Group 1, control) or 2.5, or 5.0 or 7.5 microg sufentanil (Groups 2-4, respectively). In every group, the local anaesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg) and the total volume of the solution 4 mL. The onset time of the block, maximum level of sensory block, motor block level, duration of analgesia, maternal side-effects and maternal-fetal cardiovascular repercussions were evaluated. RESULTS Onset of the block was significantly shorter in the groups receiving opioids compared with the control group. Analgesia was significantly prolonged in Groups 3 and 4. The occurrence of pruritus and somnolence was significantly higher in the group receiving sufentanil 7.5 microg than in other groups. With the exception of pruritus, no differences were observed between groups with respect to cardiovascular or other maternal effects. CONCLUSIONS The addition of sufentanil 5.0 and 7.5 microg to hyperbaric bupivacaine provided adequate anaesthesia for Caesarean section and good postoperative analgesia. Pruritus was the most common side-effect and had a significantly higher incidence when a dose of sufentanil 7.5 microg was used.
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Affiliation(s)
- A de F de Assunção Braga
- State University of Campinas, Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil.
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Tsen LC, Thomas J, Segal S, Datta S, Bader AM. Transcutaneous electrical nerve stimulation does not augment epidural labor analgesia. J Clin Anesth 2001; 13:571-5. [PMID: 11755326 DOI: 10.1016/s0952-8180(01)00332-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To evaluate whether transcutaneous electrical nerve stimulation (TENS) can increase the quality and duration of an initiation dose of bupivacaine used for the establishment of epidural labor analgesia. DESIGN Randomized, double-blind study. SETTING Tertiary-care academic medical center. PATIENTS 40 ASA physical status I and II parturients in early, active spontaneous labor with a singleton, vertex term fetus, and requesting analgesia. INTERVENTIONS A standardized epidural technique with either an active or inactive TENS unit was performed. Before epidural placement, TENS intensity thresholds were determined with electrodes placed over the paraspinus muscles at T(10)-L(1), and S(2)-S(4); TENS settings for mode, cycle, and pulse width were standardized. MEASUREMENTS Data were collected at timed intervals on pain as measured by visual analog scale (VAS), sensory level (pinprick), motor blockade (Bromage score), cervical dilation, and duration of analgesia. MAIN RESULTS The duration of analgesia produced by the initial dose of epidural bupivacaine did not differ between groups (TENS turned off 82.3 +/- 26 [mean +/- SD] vs. TENS activated 80.7 +/- 40 min, p = 0.88). Kaplan-Meier survival analysis and Mantel-Cox log rank analysis showed no difference between the two treatments (p = 0.75). No difference in the quality of analgesia was observed between the two groups. CONCLUSIONS In healthy laboring parturients, the application of a TENS unit did not alter the quality or duration of an initiation dose of bupivacaine utilized for the establishment of epidural labor analgesia.
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Affiliation(s)
- L C Tsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA.
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