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Shi L, Zhang D, Ye P, Peng W, Yin Y, Zhang Y. Clinical effect of different concentrations of ropivacaine in the labor analgesia of dural puncture epidural technique for obese puerperae. Perioper Med (Lond) 2024; 13:7. [PMID: 38355657 PMCID: PMC10868062 DOI: 10.1186/s13741-024-00363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND This study was performed to analyze the clinical effect of different concentrations of ropivacaine in the labor analgesia of the dural puncture epidural (DPE) technique for obese puerperae. METHODS One hundred and fifty first-term obese women who received vaginal delivery and required labor analgesia in our hospital were selected prospectively for this study, and divided into groups A, B, and C. The three groups of puerpera were given epidurals with different concentrations of ropivacaine (0.075%, 0.10%, and 0.125%) with sufentanil (0.5 μg/ml) for the labor analgesia regimen. The visual analog scale (VAS), Ramsay scale, and Bromage scale of puerperae before analgesia and at different time points after anesthesia, and analgesic onset time, analgesia time, first PCEA time, PCEA pressing time, ropivacaine consumption, labor time, maternal blood pressure and heart rate, maternal adverse reactions, blood gas analysis in the neonatal umbilical artery, and Apgar score were observed. RESULTS The analgesia onset time, PCEA pressing time, and ropivacaine consumption in group C were lower and the analgesia time and the first PCEA time were longer than those in groups A and B. At T1-T3 and T5, VAS scores of group A were higher than those in groups B and C, Ramsay score of group A was lower than that of groups B and C at T2-T3, and Bromage score of group C at any time point was higher than other two groups. The time of the second stage of labor in groups B and C was longer than that in group A, which in group C was longer than that in group B. Compared with groups A and C, the blood pressure and heart rate of puerperae in group B were closer to normal values. Three different concentrations of ropivacaine had no significant effect on the umbilical artery blood gas analysis indices and Apgar scores at 1st minute and 5th minute in neonates. The incidence of maternal adverse reactions in group C was lower than those in groups A and B. CONCLUSION 0.1% ropivacaine combined with 0.5 μg/ml sufentanil through DPE technique has good analgesic efficacy and few adverse effects in obese puerperae.
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Affiliation(s)
- Liping Shi
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China
| | - Difei Zhang
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China.
| | - Pengfei Ye
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China
| | - Weihua Peng
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China
| | - Yan Yin
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China
| | - Ye Zhang
- Department of Anesthesiology, Taihe County People's Hospital, Fuyang, 236600, Anhui, China
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Yin Q, Yu B, Hao H, Li G, Sun J, Kong H, Deng L. A biased coin up-and-down sequential allocation trial to determine the ED90 of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia. Front Med (Lausanne) 2024; 10:1275605. [PMID: 38259854 PMCID: PMC10800865 DOI: 10.3389/fmed.2023.1275605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To determine the 90 percent effective dose (ED90) of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia and observe its safety for parturients and neonates. Methods We conducted a prospective, double-blind, biased coin up-and-down study. We injected a fixed 2.5 mg ropivacaine combined with a designated dose of sufentanil intrathecally to observe the labor analgesic effect. The initial dose of sufentanil was assigned 1.0 μg, and the remaining doses were assigned as per the biased coin up-and-down method. The criterion of successful response was defined as VAS ≤ 30 mm after intrathecal injection at 10 min. Safety was evaluated in terms of maternal and neonatal outcomes. Results The ED90 dose of intrathecal sufentanil combined with ropivacaine 2.5 mg (0.1%, 2.5 mL) was 2.61 μg (95% CI, 2.44 to 2.70 μg) by isotonic regression. No respiratory depression, hypotension, or motor block was observed. Thirty-one (77.5%) parturients complained of pruritus, and 14 (35.0%) suffered nausea and vomiting. Three neonates reported a 1 min Apgar score of ≤7, and none reported a 5 min Apgar score of ≤7. Conclusion The ED90 of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia was 2.61 μg. The dose is safe for parturients and neonates.
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Affiliation(s)
- Qiaoli Yin
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Bin Yu
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Hua Hao
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Gang Li
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Junyan Sun
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Anesthesiology, Guolong Hospital, Yinchuan, China
| | - Hao Kong
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Liqin Deng
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
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Zhu R, Pan Q, Cao X. Comparisons of nonpharmaceutical analgesia and pharmaceutical analgesia on the labor analgesia effect of parturient women. Immun Inflamm Dis 2023; 11:e869. [PMID: 37506154 PMCID: PMC10336482 DOI: 10.1002/iid3.869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE We aimed to compare the labor analgesia effects of nonpharmaceutical analgesia and pharmaceutical analgesia on parturient women. METHODS One hundred and four parturient women with spontaneous births were selected and randomly divided into pharmaceutical and nonpharmaceutical analgesia groups. Before and after analgesia, the Visual Analogue Scale (VAS), parturient satisfaction with analgesia, serum pain stress factors (substance P [SP], neuropeptide Y [NPY], nerve growth factor [NGF], and prostaglandin E2 [PGE2]), duration of labor, vaginal bleeding at 2 h postpartum, postpartum urinary retention and dysuria incidence, Apgar score of 1 min and 5 min after birth, and neonatal cord blood gas analysis (pH, partial pressure of oxygen [PO2 ], partial pressure of carbon dioxide [PCO2 ], and lactate [Lac]) were compared in the two groups. RESULTS VAS scores were lower and the analgesia satisfaction was higher in the pharmaceutical analgesia group than in the nonpharmaceutical analgesia group (all p < .05). Serum levels of SP, NPY, NGF, and PGE2 in the pharmaceutical analgesia group were lower than those in the nonpharmaceutical analgesia group (all p < .05). The first and second stages of labor were longer and the bleeding volume at 2 h postpartum was greater in the pharmaceutical analgesia group than those in the nonpharmaceutical analgesia group (all p < .05). Reduced Lac and PCO2 levels and increased PO2 level were found in the pharmaceutical analgesia group in comparison to the nonpharmaceutical analgesia group (all p < .05). CONCLUSION This study demonstrates that the analgesic effect and neonatal condition of the pharmaceutical analgesia are better than the nonpharmaceutical analgesia, but the labor duration and postpartum bleeding volume of the pharmaceutical analgesia are greater than those of the nonpharmaceutical analgesia.
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Affiliation(s)
- Rongyu Zhu
- Department of Anesthesiology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Qin Pan
- Department of Anesthesiology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Xiaoxia Cao
- Department of Anesthesiology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
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Wang Y, Chen Z, Dang X, Jiang N, Cui K, Su S. Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: A Retrospective, Multicenter Study. Pharmacology 2022; 107:386-397. [PMID: 35609521 DOI: 10.1159/000524304] [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: 10/16/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sufentanil is used with ropivacaine in labor pain management but it can have respiratory depression. Dexmedetomidine is effective to maintain hemodynamic stability in parturient women and allow awake intubation. However, dexmedetomidine is suggested only in patients with major cardiovascular disease that mandates stable hemodynamics (Reference ID: 3987541-USFDA). The objective of the study was to compare different doses of ropivacaine either with sufentanil or with dexmedetomidine for epidural anesthesia regarding labor pain management. METHODS Parturient women have received 0.125% ropivacaine with 0.5-μg/mL sufentanil (SR1 cohort, n = 115), or 0.08% ropivacaine with 0.5-μg/mL sufentanil (SR2 cohort, n = 109), or 0.125% ropivacaine with 0.5-μg/mL dexmedetomidine (DR1 cohort, n = 124), or 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine (DR2 cohort, n = 135) for epidural anesthesia during vaginal delivery or cesarean section. RESULTS At 2-h postpartum, the visual analog scale score of parturient women of the DR2 cohort was fewer than that of parturient women of the SR1 (p < 0.0001, q = 4.162) and the SR2 (p < 0.0001, q = 7.568) cohorts and statistically the same as that of parturient women of the DR1 cohort (p < 0.0001, q = 3.087). Bradycardia and itching were reported in parturient women of the DR2 and the DR1 cohorts while nausea, vomiting, and urinary retention at 6 h were reported in parturient women of the SR1 and the SR2 cohorts. In the DR2 cohort, there were fewer numbers of parturient women with bradycardia (4 vs. 19, p < 0.0001, q = 6.613) and hypotension (2% vs. 1%) than those in the DR1 cohort. The child born by women of the DR2 cohort had high partial arterial pressure of oxygen than those born by women of the DR1 (p < 0.0001, q = 18.663), the SR1 (p < 0.0001, q = 29.366), and the SR2 (p < 0.0001, q = 24.039) cohorts. DISCUSSION/CONCLUSION Epidural 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine is an effective and safe anesthetic regimen for hypertensive parturient women and their newborns. LEVEL OF EVIDENCE III. Technical Efficacy Stage: 4.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Zhaowen Chen
- Department of Obstetrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Xiujing Dang
- Department of Anesthesiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Ning Jiang
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Kai Cui
- Department of Urological Surgery, Armed Police Shandong Corps Hospital, Jinan, China
| | - Shiyu Su
- Department of Anesthesiology, The Fifth People's Hospital of Jinan, Jinan, China
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Messina A, La Via L, Milani A, Savi M, Calabrò L, Sanfilippo F, Negri K, Castellani G, Cammarota G, Robba C, Morenghi E, Astuto M, Cecconi M. Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:19. [PMID: 37386657 DOI: 10.1186/s44158-022-00047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Spinal anesthesia (SA) is widely used for anesthetic management of patients undergoing hip surgery, and hypotension is the most common cardiovascular side effect of SA. This paper aims to assess the lowest effective dose of SA that reduces the occurrence of intraoperative hypotension in elderly patients scheduled for major lower limb orthopedic surgery. METHODS We conducted a systematic review of randomized controlled trials (RCTs) performed in elderly patients scheduled for surgical hip repair and a meta-analysis with meta-regression on the occurrence of hypotensive episodes at different effective doses of anesthetics. We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials registered. RESULTS Our search retrieved 2085 titles, and after screening, 6 were finally included in both the qualitative and quantitative analysis, including 344 patients [15% (10-28) males], with a median (25th to 75th interquartile) age of 82 (80-85). The risk of bias assessment reported "low risk" for 5 (83.3%) and "some concerns" for 1 (16.7%) of the included RCTs. The low dose of SA of [mean 6.5 mg (1.9)] anesthetic was associated with a lower incidence of hypotension [OR = 0.09 (95%CI 0.04-0.21); p = 0.04; I2 = 56.9%], as compared to the high-dose of anesthetic [mean 10.5 mg (2.4)]. CONCLUSIONS In the included studies of this meta-analysis, a mean dose of 6.5 mg of SA was effective in producing intraoperative comfort and motor block and associated with a lower incidence of hypotension as compared to a mean dose of 10.5 mg. TRIAL REGISTRATION CRD42020193627.
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Affiliation(s)
- Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Angelo Milani
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Marzia Savi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Lorenzo Calabrò
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Katerina Negri
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | | | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Emanuela Morenghi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Callahan EC, Lim S, George RB. Neuraxial labor analgesia: Maintenance techniques. Best Pract Res Clin Anaesthesiol 2022; 36:17-30. [PMID: 35659953 DOI: 10.1016/j.bpa.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
Abstract
Since the advent of neuraxial analgesia for labor, approaches to maintaining intrapartum pain relief have seen significant advancement. Through pharmacologic innovations and improved drug delivery mechanisms, current neuraxial labor analgesia maintenance techniques have been shaped by efforts to maximize patient comfort during the birthing process, while minimizing undesirable side effects and promoting the unimpeded progress of labor. To these ends, a modern anesthesiologist may avail themselves of several techniques, including programmed intermittent epidural bolus (PIEB), patient controlled epidural analgesia (PCEA) and dilute concentration local anesthetic + opioid epidural solutions. We explore the historical development and the evidential underpinnings of these techniques, in addition to several contemporary neuraxial labor analgesia practices. We also summarize current understanding of the effects these interventions have on maternal/fetal health and the labor course, as well as several important aspects of analgesic safety and monitoring.
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Affiliation(s)
- Elliott C Callahan
- Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), 513 Parnassus Ave, MSB, 436, Box 0427, San Francisco, CA 94143, USA.
| | - Stephanie Lim
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Ronald B George
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
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Kim YH, Kwon SY, Jun EH, Choi ST, Park SJ, Kim Y. Comparison of epidural, spinal, and saddle block for holmium laser enucleation of prostate (HoLEP): A prospective randomized, comparative study. Medicine (Baltimore) 2021; 100:e27534. [PMID: 34678887 PMCID: PMC8542140 DOI: 10.1097/md.0000000000027534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostate hypertrophy. The aim of the present study was to compare regional anesthesia methods for HoLEP operation and to determine the optimal technique. METHODS Sixty patients with American Society of Anesthesiologists scores of I-III were randomly allocated into 3 groups. Patients in group E received an epidural block with 75 mg of bupivacaine plus 50 μg of fentanyl. In group S, 15 mg of bupivacaine and 50 μg fentanyl were used for spinal anesthesia. In group SA, patients received saddle block with 15 mg of bupivacaine and 50 μg of fentanyl. RESULTS Time to T10 dermatome block and to maximal level block were longest in group E (P < .05), and maximal sensorial block level was higher in group E than group SA (P < .05). There was a significant difference in postoperative motor block, but no difference in systolic blood pressure and heart rate. CONCLUSION Among 3 techniques, saddle block might be preferable in HoLEP because an adequate sensorial level was achieved with lower motor block and stable hemodynamics.
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Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and pain medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - So Young Kwon
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Eun Hwa Jun
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Seung Tae Choi
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Seong Jin Park
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Yumi Kim
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
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Zhang L, Xu C, Li Y. Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study. BMC Anesthesiol 2021; 21:229. [PMID: 34551718 PMCID: PMC8456635 DOI: 10.1186/s12871-021-01450-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes. METHODS This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid. RESULTS There were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group. CONCLUSIONS 0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine. TRIAL REGISTRATION Clinical Research Information Service with registration number ChiCTR2100045162 . Registered 7 April 2021.
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Affiliation(s)
- Le Zhang
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Chengjie Xu
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yue Li
- Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China.
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Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries. Anesthesiology 2021; 135:350-365. [PMID: 34237130 DOI: 10.1097/aln.0000000000003844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Opioids are a mainstay of treatment for pain worldwide. Pruritus, a common side effect of opioids, is a patient dissatisfier that limits their use in many clinical settings. Both parenteral and neuraxial administration of opioids frequently evoke pruritus. The ability of opioids to suppress pain while causing itch continues to perplex clinicians and researchers alike. Several mechanisms have been proposed to explain how opioids can give rise to pruritus, but specific knowledge gaps perpetuate debate. This review summarizes the clinical burden of opioid-induced pruritus and emphasizes recent discoveries of peripheral and central mechanisms for opioid-induced pruritus, particularly with respect to scientific and conceptual advances in spinal cord circuitry and mast cell biology. The mechanisms and effectiveness of existing medications used for clinical management of pruritus will be evaluated, and we will highlight the emerging preclinical utility of selective κ-opioid receptor agonists, such as nalfurafine, for the management of opioid-induced pruritus.
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Liu Z, Xu S, Ji Z, Xu H, Zhao W, Xia Z, Xu R. Mechanistic study of mtROS-JNK-SOD2 signaling in bupivacaine-induced neuron oxidative stress. Aging (Albany NY) 2021; 12:13463-13476. [PMID: 32658869 PMCID: PMC7377901 DOI: 10.18632/aging.103447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/23/2020] [Indexed: 12/27/2022]
Abstract
Manganese superoxide dismutase (SOD2) is a key enzyme to scavenge free radical superoxide in the mitochondrion. SOD2 deficiency leads to oxidative injury in cells. Bupivacaine, a local anesthetic commonly used in clinic, could induce neurotoxic injury via oxidative stress. The role and the mechanism of SOD2 regulation in bupivacaine-induced oxidative stress remains unclear. Here, bupivacaine was used to treat Sprague-Dawley rats with intrathecal injection and culture human neuroblastoma cells for developing vivo injury model and vitro injury model. The results showed that bupivacaine caused the over-production of mitochondrial reactive oxygen species (mtROS), the activation of C-Jun N-terminal kinase (JNK), and the elevation of SOD2 transcription. Decrease of mtROS with N-acetyl-L-cysteine attenuated the activation of JNK and the increase of SOD2 transcription. Inhibition of JNK signaling with a small interfering RNA (siRNA) or with sp600125 down-regulated the increase of SOD2 transcription. SOD2 gene knock-down exacerbated bupivacaine-induced mtROS generation and neurotoxic injury but had no effect on JNK phosphorylation. Mito-TEMPO (a mitochondria-targeted antioxidant) could protect neuron against bupivacaine-induced toxic injury. Collectively, our results confirm that mtROS stimulates the transcription of SOD2 via activating JNK signaling in bupivacaine-induced oxidative stress. Enhancing antioxidant ability of SOD2 might be crucial in combating bupivacaine-induced neurotoxic injury.
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Affiliation(s)
- Zhongjie Liu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhonghua Ji
- Department of Anesthesiology, Affiliated Zhuhai Hospital of Jinan University, Zhuhai, Guangdong Province, China
| | - Huali Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wei Zhao
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhengyuan Xia
- Department of Anesthesiology, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Rui Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Mei Z, Ngan Kee WD, Sheng ZM, Hu LJ, Wu ZH, Lyu CC, Chen XZ, Qian XW. Comparative dose-response study of hyperbaric ropivacaine for spinal anesthesia for cesarean delivery in singleton versus twin pregnancies. J Clin Anesth 2020; 67:110068. [DOI: 10.1016/j.jclinane.2020.110068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/24/2020] [Accepted: 09/19/2020] [Indexed: 11/15/2022]
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Kang HY, Lee CH, Choi SS, Lee MK, Park JS, Oh JS. Comparison of ropivacaine with ropivacaine and fentanyl in continuous epidural analgesia for postherpetic neuralgia: A STROBE-compliant retrospective study. Medicine (Baltimore) 2020; 99:e20298. [PMID: 32481399 DOI: 10.1097/md.0000000000020298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Continuous epidural analgesia (CEA) using local anesthetics is frequently used to control herpes zoster pain and prevent postherpetic neuralgia (PHN). However, few studies have been conducted to determine the efficacy of epidural drugs administered as CEA to manage PHN. This retrospective study was designed to evaluate the effectiveness of CEA with ropivacaine alone or with ropivacaine and fentanyl for controlling pain caused by PHN.We reviewed the medical records of 71 patients. We studied 2 groups: epidural ropivacaine (ER; CEA with ropivacaine alone; n = 44) and epidural ropivacaine and fentanyl (Epidural ropivacaine and fentanyl (ERF); CEA with ropivacaine and fentanyl; n = 27). To evaluate pain, a numeric rating scale (NRS) was evaluated at 6 time points: immediately before the procedure (baseline NRS score); 1 hour after the procedure; 14 days after the procedure; and 1, 3, and 6 months after the procedure. Complication rates were recorded during CEA. We also investigated whether additional invasive procedures were needed due to insufficient pain control during the 6-month follow-up period.After adjusting for confounding variables, there were no significant differences in the NRS scores between the 2 groups at any time point. The adjusted odds ratio for additional invasive procedures within 6 months after CEA was 1.03-times higher in the ERF group than in the ER group, but this difference was not statistically significant (95% confidence interval: 0.33-3.23, P = .96). Rates of complication (dysuria, vomiting, nausea, itching sensation, and hypotension) during CEA were higher in the ERF group than in the ER group. However, the differences were not statistically significant.There was no difference in the management of pain in patients with PHN between the groups. Epidural administration of fentanyl with ropivacaine did not improve pain management when compared to ropivacaine alone. Although not statistically significant, the incidence of complications during CEA was higher in the opioid combination group.
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Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Dongdaemun-Gu
| | - Chung Hun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea
| | - Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea
| | - Mi Kyoung Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea
| | - Jong Sun Park
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea
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13
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Kang HY, Lee CH, Choi SS, Lee MK, Lee YJ, Park JS. Comparison of the Analgesic Effect of Ropivacaine with Fentanyl and Ropivacaine Alone in Continuous Epidural Infusion for Acute Herpes Zoster Management: A Retrospective Study. ACTA ACUST UNITED AC 2020; 56:medicina56010022. [PMID: 31936282 PMCID: PMC7022602 DOI: 10.3390/medicina56010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022]
Abstract
Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22–1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group.
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Affiliation(s)
- Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyungheedae Road 23, Dongdaemun-Gu, Seoul 02447, Korea;
| | - Chung Hun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul 08308, Korea; (S.S.C.); (M.K.L.); (Y.J.L.); (J.S.P.)
- Correspondence:
| | - Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul 08308, Korea; (S.S.C.); (M.K.L.); (Y.J.L.); (J.S.P.)
| | - Mi Kyoung Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul 08308, Korea; (S.S.C.); (M.K.L.); (Y.J.L.); (J.S.P.)
| | - Yeon Joo Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul 08308, Korea; (S.S.C.); (M.K.L.); (Y.J.L.); (J.S.P.)
| | - Jong Sun Park
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul 08308, Korea; (S.S.C.); (M.K.L.); (Y.J.L.); (J.S.P.)
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14
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Cheng Q, Bi X, Zhang W, Lu Y, Tian H. Dexmedetomidine versus sufentanil with high- or low-concentration ropivacaine for labor epidural analgesia: A randomized trial. J Obstet Gynaecol Res 2019; 45:2193-2201. [PMID: 31502323 DOI: 10.1111/jog.14104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
AIM To study analgesic effects of dexmedetomidine or sufentanil, both combined with ropivacaine, in epidural analgesia during labor. METHODS We recruited 160 primigravidae with full-term pregnancy who received epidural anesthesia during labor and randomized them into four groups to receive epidural administration of ropivacaine combined with sufentanil (RS1 and RS2 groups) or with dexmedetomidine (RD1 and RD2 groups). Systolic blood pressure, diastolic blood pressure and heart rate before anesthesia (T1 ), 15 min after anesthesia induction (T2 ), on delivery (T3 ) and 2 h postpartum (T4 ), together with visual analogue scale scores, Bromage scores, Ramsay scores, adverse reactions during analgesia and urinary retention at 6 and 24 h postpartum were recorded; the pH, PCO2 and PO2 of umbilical cord arterial blood and Apgar scores at 1, 5 and 10 min after childbirth were assessed. RESULTS RS1 group had significantly lower systolic blood pressure, diastolic blood pressure and heart rate than RD1 group at T2 and T3 (all P < 0.05), but not at T1. At T2 and T3 , the other three groups were lower than RS2 group in visual analogue scale and Ramsay scores (all P < 0.05). After childbirth, RD2 group had significantly higher PO2 result than other three groups (P < 0.05). At 6 h postpartum, RD2 group had significantly fewer cases of urinary retention than RD1 and RS1 groups (both P < 0.05). CONCLUSION A relatively low concentration of ropivacaine, combined with dexmedetomidine, is better in analgesia during labor.
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Affiliation(s)
- Qiuju Cheng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Xiaobao Bi
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Weiqiang Zhang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Yanling Lu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Hang Tian
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
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Habib AS. What’s New in Obstetric Anesthesia? The 2017 Gerard W. Ostheimer Lecture. Anesth Analg 2019; 129:168-175. [DOI: 10.1213/ane.0000000000004188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Sharpe EE, Kim GY, Vinzant NJ, Arendt KW, Hanson AC, Martin DP, Sviggum HP. Need for additional anesthesia after single injection spinal analgesia for labor: a retrospective cohort study. Int J Obstet Anesth 2019; 40:45-51. [PMID: 31235213 DOI: 10.1016/j.ijoa.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is little information about the use and efficacy of single injection spinal blocks for labor analgesia; specifically, how frequently subsequent analgesia or anesthesia is needed. This study determined how frequently an additional anesthetic intervention was needed in women who received single injection spinal analgesia. METHODS This retrospective study examined electronic medical records to find all single injection spinal analgesic blocks for labor analgesia over a 14-year (2003-2016) period. Patient and block characteristics and patient outcomes were recorded. The primary outcome was need for an additional anesthetic intervention following single injection spinal for labor analgesia. RESULTS Four-hundred-and-twenty-eight patients received single injection spinal blocks for labor and 60 (14.0%) needed an additional anesthetic either for labor analgesia (n=49) or an unexpected procedure (n=11). Two of these (0.5%) required general anesthesia. Parity of zero (nulliparous), a low cervical dilation at the time of the spinal injection, and induction of labor status, were associated with an increased risk of needing an additional anesthetic intervention. CONCLUSIONS This retrospective review provides evidence that single injection spinal anesthesia may be used for multiparous women with spontaneous labor and more advanced cervical dilation.
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Affiliation(s)
- E E Sharpe
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - G Y Kim
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, USA
| | - N J Vinzant
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, USA
| | - K W Arendt
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - A C Hanson
- Department of Biostatistics, Mayo Clinic, Rochester, USA
| | - D P Martin
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - H P Sviggum
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA.
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The Effect of Spinal Hyperbaric Bupivacaine-Fentanyl or Hyperbaric Bupivacaine on Uterine Tone and Fetal Heart Rate in Laboring Women: A Randomized Controlled Study. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/01.aoa.0000557693.21956.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li TY, Lu IC, Cheng KI, Huang HF. Fentanyl with low concentration ropivacaine induced less motor blockade in epidural analgesia. Kaohsiung J Med Sci 2019; 35:183-184. [PMID: 30887721 DOI: 10.1002/kjm2.12030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tzu-Ying Li
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fang Huang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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19
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A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes. Anesthesiology 2019; 129:192-215. [PMID: 29561267 DOI: 10.1097/aln.0000000000002182] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obstetric anesthesia has evolved over the course of its history to encompass comprehensive aspects of maternal care, ranging from cesarean delivery anesthesia and labor analgesia to maternal resuscitation and patient safety. Anesthesiologists are concerned with maternal and neonatal outcomes, and with preventing and managing complications that may present during childbirth. The current review will focus on recent advances in obstetric anesthesia, including labor anesthesia and analgesia, cesarean delivery anesthesia and analgesia, the effects of maternal anesthesia on breastfeeding and fever, and maternal safety. The impact of these advances on maternal and neonatal outcomes is discussed. Past and future progress in this field will continue to have significant implications on the health of women and children.
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20
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Hussien RM, Rabie AH. Sequential intrathecal injection of fentanyl and hyperbaric bupivacaine at different rates: does it make a difference? A randomized controlled trial. Korean J Anesthesiol 2019; 72:150-155. [PMID: 30622224 PMCID: PMC6458505 DOI: 10.4097/kja.d.18.00173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have shown that sequential intrathecal injection of fentanyl and hyperbaric bupivacaine for cesarean section (CS) anesthesia provides a superior anesthetic effect than use of bupivacaine alone, and prolongs postoperative analgesia. Herein, we investigated whether rapid intrathecal injection of fentanyl followed by slow injection of hyperbaric bupivacaine affects the duration of postoperative analgesia, the effectiveness of anesthesia, and hemodynamic status. Methods Fifty-six parturients with American Society of Anesthesiologists physical status I or II, aged 18–40 years, and scheduled to undergo elective CS were randomly assigned to 2 groups of 28 patients each. The normal sequential group received sequential intrathecal injections of fentanyl and hyperbaric bupivacaine at the same rate, each with a 5 ml syringe. The rapid sequential group received a rapid intrathecal injection of fentanyl with an insulin syringe, followed by a slow injection of hyperbaric bupivacaine with a 5 ml syringe. The onset of sensory block, the timing of the first rescue analgesia, the doses of rescue analgesics, the degree of postoperative pain, the onset and duration of motor block, the incidence and duration of hypotension, and spinal anesthesia-related complications were recorded. Results While both approaches had comparable spinal anesthesia-related complications, incidence and duration of hypotension, and doses of ephedrine, the rapid sequential group exhibited a more rapid onset of sensory block, a higher sensory level, and more prolonged postoperative analgesia. Conclusions Rapid sequential injection of fentanyl and hyperbaric bupivacaine produced superior anesthesia and more prolonged postoperative analgesia than sequential injections of both at the same rate.
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Affiliation(s)
| | - Amal H Rabie
- Lecturer of Anesthsia, Ain Shams University, Cairo, Egypt
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21
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Daramola B. Preliminary investigation on antioxidant interactions between bioactive components of Solanum anguivi and Capsicum annuum. Journal of Food Science and Technology 2018; 55:3827-3832. [PMID: 30150843 DOI: 10.1007/s13197-018-3267-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
Evaluation of antioxidative interaction between two fruits of contra-similar characteristics belonging to same botanical family Solanacea namely S. anguivi and Capsicum annuum was accomplished in this study. The relative reducing power (RRP) and radical scavenging activity (RSA) of the mixture (11:0, 10:1, 5:1, 2:1, 1:1, 1:2, 1:5,1:10, 0:11) with antioxidant interaction range of 0.6958-2.4244 and 0.724-1.648 was obtained for RRP and RSA respectively for acetone-hexane derived extract. Similarly antioxidant interaction range from 1.045-1.486 to 1.0969-1.3166 was obtained for RRP and RSA respectively for ethanolic extract samples.This study demonstrated enhanced activity of S. anguivi and C. annuum when used as a mixture in comparison to when used alone. These results suggested that application of S. anguivi and C. annuum as mixture decreased intensity of undesirable sensory properties of high intensity bitterness and hot pungency associated with S. anguivi and C. annuum respectively without the use of taste masking agents.
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Affiliation(s)
- B Daramola
- Department of Food Technology, Federal Polytechnic, PMB 5351, Ado-Ekiti, Ekiti State Nigeria
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Galica RJ, Hayek SM, Veizi E, McEwan MT, Katta S, Ali O, Aziz N, Sondhi N. Intrathecal Trialing of Continuous Infusion Combination Therapy With Hydromorphone and Bupivacaine in Failed Back Surgery Patients. Neuromodulation 2017; 21:648-654. [PMID: 29206315 DOI: 10.1111/ner.12737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/17/2017] [Accepted: 10/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Intrathecal (IT) trial is a prognostic interventional pain management procedure employed to determine the potential success of treating intractable pain with an implantable infusion device system. There is a dearth of data regarding trials with continuous infusion of combination therapy (e.g. opioid combined with local anesthetic). The objective of the this study was to determine the overall outcomes of continuous infusion IT trials and factors influencing long-term success of IT therapy in patients with chronic intractable pain post-laminectomy. MATERIALS AND METHODS This is a retrospective analysis of all patients with lumbar failed back surgery syndrome (FBSS) who were trialed with a combination of hydromorphone and bupivacaine with a temporary externalized IT catheter from March 2007 to June 2014. RESULTS From a cohort of 62 patients fulfilling the inclusion criteria, 54 (87.10%) patients had successful IT trials. No significant differences were found between successful and failed trial patients with regards to age, sex, pre-trial pain numeric rating scale scores, pre-trial morphine equivalent daily dose, or trial dosages. Significant positive correlations were found between pretrial oral opioid intake and end of trial hydromorphone dose and hydromorphone dose escalation at 12 months and 24 months. CONCLUSIONS Patients with refractory low back pain due to FBSS who underwent successful combination IT trial with hydromorphone and bupivacaine infused through a temporary IT catheter had significantly improved pain intensity scores following permanent implant. Higher pre-trial MEDD was correlated with higher trial and post-implant opioid doses and higher rates of opioid dose escalation post-implant.
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Affiliation(s)
- Ryan J Galica
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Salim M Hayek
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Elias Veizi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA.,Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | - Matthew T McEwan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Sivakanth Katta
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Omar Ali
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Nida Aziz
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Nidhi Sondhi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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Abstract
Abstract
Background
Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia.
Methods
The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured.
Results
A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, −58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum.
Conclusions
Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.
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Fairchild E, Roberts L, Zelman K, Michelli S, Hastings-Tolsma M. Implementation of Robert's Coping with Labor Algorithm © in a large tertiary care facility. Midwifery 2017; 50:208-218. [PMID: 28477459 DOI: 10.1016/j.midw.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/12/2017] [Accepted: 03/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE to implement use of Roberts' Coping with Labor Algorithm© (CWLA) with laboring women in a large tertiary care facility. DESIGN this was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation. SETTING the project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year. PARTICIPANTS full, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change. FINDINGS a majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice. IMPLICATIONS FOR PRACTICE this work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.
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Affiliation(s)
- Esther Fairchild
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States.
| | - Leissa Roberts
- University of Utah, School of Nursing,10 South 2000 East, Salt Lake City, Utah 84112, United States
| | - Karen Zelman
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
| | - Shelley Michelli
- Baylor Scott & White, Fort Worth's Andrews Women's Hospital,1400 8th Avenue Fort Worth, TX 76104, United States
| | - Marie Hastings-Tolsma
- Baylor University, Louise Herrington School of Nursing, 3700 Worth St, Dallas, TX 75246, United States
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DeRossi R, Pagliosa RC, de Carvalho AQ, Macedo GG, Hermeto LC. Fentanyl and methadone used as adjuncts to bupivacaine for lumbosacral epidural analgesia in sheep. Vet Rec 2017; 180:96. [DOI: 10.1136/vr.103860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/04/2022]
Affiliation(s)
- R. DeRossi
- Department of Veterinary Medicine-Surgery and Anesthesiology, Faculty of Veterinary Medicine and Animal Science; Federal University of Mato Grosso do Sul; Campo Grande, Mato Grosso do Sul Brazil
| | - R. C. Pagliosa
- Department of Veterinary Medicine-Surgery and Anesthesiology, Faculty of Veterinary Medicine and Animal Science; Federal University of Mato Grosso do Sul; Campo Grande, Mato Grosso do Sul Brazil
| | - A. Q. de Carvalho
- Department of Veterinary Medicine-Surgery and Anesthesiology, Faculty of Veterinary Medicine and Animal Science; Federal University of Mato Grosso do Sul; Campo Grande, Mato Grosso do Sul Brazil
| | - G. G. Macedo
- Department of Animal Reproduction, Faculty of Veterinary Medicine; Federal University of Uberlândia; Uberlândia, Minas Gerais Brazil
| | - L. C. Hermeto
- Postdoctoral Postgraduate Program on Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science; Federal University of Mato Grosso do Sul (UFMS); Campo Grande Brazil
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Dose-Response Curves for Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine Given for Labor Analgesia in Nulliparous Women. Reg Anesth Pain Med 2017; 42:788-792. [DOI: 10.1097/aap.0000000000000657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kumar A, Kumar R, Verma VK, Prasad C, Kumar R, Kant S, Kumar G, Singh N, Kumari R. A randomized controlled study between fentanyl and Butorphanol with low dose intrathecal bupivacaine to facilitate early postoperative ambulation in urological procedures. Anesth Essays Res 2016; 10:508-511. [PMID: 27746542 PMCID: PMC5062196 DOI: 10.4103/0259-1162.179320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects. The present study was conducted to decrease the overall dose of local anesthetics with opioid combination for urological procedure with respect to quality of anesthesia and recovery with patient's satisfaction. Materials and Methods: The study population was randomly allocated by computer generated table into two groups; Group A: 5 mg 0.5% bupivacaine + 25 mcg and Group B: 5 mg 0.5% bupivacaine + 25 mg butorphanol. Results: Highest level of sensory block was T9 and T8 with the fentanyl group and butorphanol group, respectively. The onset of sensory block was early in fentanyl group than butorphanol group. Duration of both sensory and motor block was significantly higher in butorphanol group. There was no incidence of itching in both groups. There were two patients in fentanyl group and one in butorphanol with hypotension for which injection mephentermine was given. Two patients in fentanyl group complained of nausea and vomiting, for which injection ondansetron was given. One patient complained of pain in fentanyl group for which injection propofol with injection fentanyl was supplemented. Conclusion: Low-dose bupivacaine with butorphanol group was devoid of any side effects in the present study but low dose bupivacaine in addition with fentanyl is superior in terms of early postoperative recovery resulting in early discharge and better outcome in comparison to bupivacaine and butorphanol group, which is beneficial in elderly patients with comorbidity.
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Affiliation(s)
- Arvind Kumar
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Ritesh Kumar
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Vinod Kumar Verma
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Chandrakant Prasad
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Rajesh Kumar
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Shashi Kant
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Gunjan Kumar
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Neha Singh
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
| | - Rupam Kumari
- Department of Anaesthesiology and Critical Care, IGIMS, Patna, Bihar, India
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Wang X, Xu S, Qin X, Li X, Feng SW, Liu Y, Wang W, Guo X, Shen R, Shen X, Wang F. Comparison Between the Use of Ropivacaine Alone and Ropivacaine With Sufentanil in Epidural Labor Analgesia. Medicine (Baltimore) 2015; 94:e1882. [PMID: 26512604 PMCID: PMC4985418 DOI: 10.1097/md.0000000000001882] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 09/28/2015] [Accepted: 10/02/2015] [Indexed: 11/26/2022] Open
Abstract
To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil given epidurally on the labor pain control.After institutional review board approval and patient consent, a total of 500 nulliparas requesting epidural labor analgesia were enrolled and 481 eventually were randomized into 2 groups: a sole local anesthetic group (ropivacaine 0.125%) and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine + 0.3 μg/mL sufentanil). After the test dose, a 10-mL epidural analgesic solution was given in a single bolus, followed by intermittent bolus injection of 10 to 15 mL of the solution. The primary outcome was the analgesic efficacy measured using Numerical Rating Scale (NRS) of pain. Other maternal and infant variables were evaluated as secondary outcomes.A total of 346 participants completed the study. The median NRS pain score during the 1st stage of labor was significantly lower in the combination group 2.2 (interquartile range [IQR]: 1.8-2.7) comparing to the sole local analgesic group 2.4 (IQR: 2.0-2.8) (P < 0.0001). No significant difference was observed in NRS pain score prior epidural analgesia and during the 2nd stage of labor. Patients in both groups rated same satisfaction of analgesia. Patients in the sole local analgesic group experienced fewer side effects than those in the combination group (37.7% vs 47.2%, P = 0.082). The individual analgesia-related cost in the sole local analgesic group was less ($5.7 ± 2.06) than that in the combination group ($9.76 ± 3.54) (P < 0.0001). The incidence of 1-minute Apgar ≤ 7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P = 0.038). No difference was found between other secondary outcomes.The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil at different stages of labor (ΔNRS = 0.2) but the former has less side effects, lower cost, and less incidence of lower 1-minute Apgar scoring. These results imply the necessity of a systematic reevaluation of epidural labor analgesia with sole local anesthetics against combination regimens of local anesthetics and other opioids.
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Affiliation(s)
- Xian Wang
- From the Department of Anesthesiology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China (XW, SX, XQ, XL, SWF, YL, WW, XS, FW); Institute of Pediatrics, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China (XG, RS); and Division of Neuroscience, The Bonoi Academy of Science and Education, Chapel Hill, NC, USA (FW)
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Parate LH, Manjrekar SP, Anandaswamy TC, Manjunath B. The effect of addition of low dose fentanyl to epidural bupivacaine (0.5%) in patients undergoing elective caesarean section: A randomized, parallel group, double blind, placebo controlled study. J Postgrad Med 2015; 61:27-31. [PMID: 25511214 PMCID: PMC4944362 DOI: 10.4103/0022-3859.147032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/10/2014] [Accepted: 08/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioids have synergistic action with local anesthetics which may alter characteristics of epidural block. Giving opioids to mother before delivery of baby is still fully not accepted with some fearing risk of neonatal depression. AIMS Our primary aim was to evaluate the analgesic effect of addition of 50 μg fentanyl to epidural 0.5% bupivacaine in patients undergoing elective caesarean section using visual analog scale. The secondary aim was to assess onset of analgesia, volume of drug required to achieve T6 level, grade and duration of motor block and Apgar score. MATERIALS AND METHODS In this prospective, randomized, double blind, placebo controlled study 64 patients scheduled for elective caesarean section under epidural anesthesia were randomly divided into two groups of 32 each. The fentanyl group received 1 ml of 50 μg fentanyl and the saline group received 1 ml of normal saline mixed with 10 ml of 0.5% bupivacaine for epidural anesthesia. VAS score, time to achieve T6 level, dose of bupivacaine, intraoperative analgesic consumption and duration of analgesia, grade and duration of motor block and any adverse maternal and neonatal effects were noted. STATISTICAL ANALYSIS Data was analyzed using Students t test, chi-square test and Mann-Whitney U-test. The values of P<0.05 were considered statistically significant. RESULTS Fentanyl improved the VAS score significantly (1.6±1.32) compared to the saline group (3.77±1.0, P<0.0001). It also reduced the intraoperaitve analgesic supplementation compared to the saline group. (P=0.031). The postoperative duration of analgesia was prolonged in the fentanyl group (275.80±13.61 min) compared to the saline group (191.47±12.16 min, P<0.0001). The other characteristics of epidural block were unaltered. CONCLUSION Addition of 50 μg fentanyl to epidural 0.5% bupivacaine significantly reduces the VAS score. It also reduces intra-operative analgesia supplementation and prolongs the duration of postoperative analgesia without altering the other characteristics of block. The neonatal outcome is not affected with addition of fentanyl before delivery of baby.
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MESH Headings
- Adult
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Anesthesia, Epidural
- Anesthesia, Obstetrical
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Bupivacaine/administration & dosage
- Bupivacaine/adverse effects
- Cesarean Section
- Dose-Response Relationship, Drug
- Double-Blind Method
- Female
- Fentanyl/administration & dosage
- Humans
- Infant, Newborn
- Injections, Epidural
- Pain Measurement
- Pain, Postoperative/drug therapy
- Pregnancy
- Prospective Studies
- Treatment Outcome
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Affiliation(s)
- LH Parate
- Department of Anaesthesia, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - SP Manjrekar
- Department of Anaesthesia, Indira Gandhi Medical College, Nagpur, Maharashtra, India
| | - TC Anandaswamy
- Department of Anaesthesia, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - B Manjunath
- Department of Community Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
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