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Wu S, Lu Y, Zhang Z, Zhong L, Dai H, Fang C, Huang M, Liu Z, Wu L. Real-time analgesic efficacy and factors determining drug requirements of combined spinal-epidural analgesia for labor: a prospective cohort study. J Anesth 2024:10.1007/s00540-024-03368-8. [PMID: 38967786 DOI: 10.1007/s00540-024-03368-8] [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: 05/09/2023] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia. METHODS This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed. RESULTS Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level. CONCLUSION Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia. CLINICAL TRIAL NUMBER AND REGISTRY Clinicaltrials.gov (ChiCTR2100051809).
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Affiliation(s)
- Shuzhen Wu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Yaxin Lu
- Big Data and Artificial Intelligence Center, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, Guangdong, 510630, China
| | - Zijing Zhang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Linjia Zhong
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Hongfei Dai
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Changping Fang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Minli Huang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Zifeng Liu
- Big Data and Artificial Intelligence Center, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, Guangdong, 510630, China
| | - Lingling Wu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, 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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Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis. Br J Anaesth 2022; 129:567-580. [PMID: 35934529 PMCID: PMC9575042 DOI: 10.1016/j.bja.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background Epidural-related maternal fever in women in labour has consequences for the mother and neonate. There has been no systematic review of preventive strategies. Methods RCTs evaluating methods of preventing or treating epidural-related maternal fever in women in active labour were eligible. We searched MEDLINE, EMBASE, CINAHL, Web of Science, CENTRAL, and grey literature sources were searched from inception to April 2021. Two review authors independently undertook study selection. Data extraction and quality assessment was performed by a single author and checked by a second. The Cochrane Risk of Bias 2 tool was used. Meta-analyses for the primary outcome, incidence of intrapartum fever, were performed using the DerSimonian and Laird random effects model to produce summary risk ratios (RRs) with 95% confidence intervals (95% CIs). Results Forty-two records, representing 34 studies, were included. Methods of reduced dose epidural reduced the incidence of intrapartum fever, but this was not statistically significant when six trials at high risk of bias were removed (seven trials; 857 participants; RR=0.83; 95% CI, 0.41–1.67). Alternative methods of analgesia and high-dose prophylactic systemic steroids reduced the risk of intrapartum fever compared with epidural analgesia. Prophylactic paracetamol was not effective. Conclusions There is no clear evidence to support the use of any individual preventative or therapeutic intervention for epidural-related maternal fever. Further research should focus on understanding the mechanism of fever development to enable RCTs of potential interventions to reduce the incidence of intrapartum fever development and the subsequent disease burden felt by the neonate. Clinical trial registration CRD42021246929.
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Jung KT, So KY, Kim SU, Kim SH. The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study. ACTA ACUST UNITED AC 2021; 57:medicina57010042. [PMID: 33419086 PMCID: PMC7825461 DOI: 10.3390/medicina57010042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
Background and objectives: The fixed-rate continuous background infusion mode with bolus dosing is a common modality for intravenous patient-controlled analgesia (PCA). However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM) where the background injection rate varies depending on the patient’s bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated to either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data on bolus demand count, total infused volume, and background infusion rate were downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (p = 0.621), decreasing with time in both groups (p < 0.001). The bolus demand count was not significantly different between groups throughout (p = 0.756). The mean total cumulative infused PCA volume was lower in group OBIM (84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM (102 (97.8−106.0) mL; p < 0.001). The total cumulative opioid dose in fentanyl equivalents, after converting sufentanil to fentanyl using an equipotential dose ratio, was lower in group OBIM (714.1 (647.4−780.9) μg) than in group TBIM (963.7 (870.5−1056.9) μg); p < 0.001). The background infusion rate was significantly different between groups throughout the study period (p < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour and lower from the 18th to the 48th postoperative hour. Conclusions: The OBIM combined with bolus dosing reduces the cumulative PCA volume and opioid consumption compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea; (K.T.J.); (K.Y.S.)
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Keum Young So
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea; (K.T.J.); (K.Y.S.)
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Seung Un Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea; (K.T.J.); (K.Y.S.)
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
- Correspondence: ; Tel.: +82-62-2203223
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Kaçmaz O, Gülhaş N, Erdoğan Kayhan G, Durmuş M. Effects of different epidural initiation volumes on postoperative analgesia in cesarean section. Turk J Med Sci 2020; 50:1955-1962. [PMID: 32682357 PMCID: PMC7775685 DOI: 10.3906/sag-1905-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/15/2020] [Indexed: 11/27/2022] Open
Abstract
Background/aim The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections. Materials and methods Eighty-one pregnant women, aged 18–45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 μg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively. Results There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.
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Affiliation(s)
- Osman Kaçmaz
- Department of Anesthesiology and Reanimation, Malatya Traning and Research Hospital, Malatya, Turkey
| | - Nurcin Gülhaş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Gülay Erdoğan Kayhan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mahmut Durmuş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, İnönü University, Malatya, Turkey
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Sodha S, Reeve A, Fernando R. Central neuraxial analgesia for labor: an update of the literature. Pain Manag 2017; 7:419-426. [PMID: 28936908 DOI: 10.2217/pmt-2017-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Numerous techniques are in use to provide analgesia for labor, of which central neuraxial block is widely considered superior to non-neuraxial options. Central neuraxial techniques have evolved over many years to provide greater efficacy, safety and maternal satisfaction. This narrative review focuses on the literature relating to central neuraxial labor analgesia from the past 5 years, from November 2010 to October 2015. We discuss the evidence related to the various central neuraxial techniques used, the increasingly widespread use of ultrasound guidance and the evidence surrounding other novel methods of central neuraxial block insertion. The timing of institution of central neuraxial analgesia in labor is considered, as are the advances in maintenance regimens for labor analgesia.
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Affiliation(s)
- Serena Sodha
- Obstetric Anaesthesia Research Fellow, Department of Anesthesia, University College Hospital, London, UK
| | - Alexandra Reeve
- Consultant, Department of Anesthesia, University College Hospital, London, UK
| | - Roshan Fernando
- Consultant, Department of Anesthesia, University College Hospital, London, UK
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