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Vijapurkar S, Sandeep G, Kalbande JV, Merin Thomas S, Singha SK. Knowledge, Attitude, and Practices of Labor Analgesia Amongst Obstetric Residents: A Cross-Sectional Survey. Cureus 2024; 16:e62326. [PMID: 39011223 PMCID: PMC11247256 DOI: 10.7759/cureus.62326] [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] [Accepted: 06/13/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Labor analgesia plays a crucial role in ensuring a comfortable and positive birthing experience. It provides physiological benefits to both the mother and the child. Knowledge, awareness, and communication between the anesthesiologist and the obstetrician are essential for the safe conduct of labor analgesia. We conducted this cross-sectional online survey amongst obstetric residents to assess their knowledge, attitude, and practices of labor analgesia. METHODS A structured questionnaire consisting of 19 questions was circulated amongst obstetric residents of various hospitals via electronic mode of communication. The responses were analyzed using statistical methods. RESULTS Among the obstetric residents that we surveyed, 75.7% of them only sometimes employed labor analgesia for their patients. The most commonly employed methods of pain relief are opioids and non-steroidal anti-inflammatory drugs (NSAID). Most of them feel that pain-free labor is necessary because it makes the whole labor process a pleasurable one. Labor analgesia was mostly advocated at patients' request and demand. The barrier to using labor analgesia was most commonly found to be the non-availability of labor analgesia services. CONCLUSION Despite the increasing awareness of labor analgesia there still lies a gap between the attitude toward it and the practice of it. Further education to rectify the misconceptions and barriers needs to be taken for providing beneficial services to pregnant females.
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Affiliation(s)
- Swati Vijapurkar
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Gade Sandeep
- Cardiac Anesthesia, All India Institute of Medical Sciences, Raipur, Raipur, IND
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Jitendra V Kalbande
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sandra Merin Thomas
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Subrata K Singha
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Rodrigues R, Freitas C, Gonçalves B, Freitas J, Abreu J. Childbirth Experience and Pain Control: Expectation, Satisfaction, and Analgesia Myths. Cureus 2024; 16:e63082. [PMID: 39055406 PMCID: PMC11270153 DOI: 10.7759/cureus.63082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND In our days, increasing importance has been given to maternal satisfaction as a quality indicator in healthcare services. A positive childbirth experience should meet a woman's personal and sociocultural beliefs and expectations in every setting. This study aimed to evaluate childbirth experience regarding expectations, satisfaction, and myths around epidural analgesia. METHODOLOGY A cross-sectional survey designed was carried out in the Obstetric Department of a public hospital in Madeira-Portugal. A well-structured questionnaire was applied to 101 post-partum women covering aspects such as sociodemographic details, childbirth expectations, overall satisfaction, and prevailing myths. IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY) was used for data analysis. RESULTS From the total of 101 participants, 32 (31%) women belonged to the 31-35 age group. Among the respondents, 58 (57%) had attained a high school diploma. The results showed that there was a positive experience with childbirth; out of the total women, 79 (78%) considered it exceeded their expectations. The majority of pregnant women (93, 92%) received neuraxial analgesia for labor, reporting the experience as good or excellent. The overall satisfaction related to the birth experience was good or excellent for 88 (87%) women. Regarding the myths, education level was significantly associated with the myth Epidurals often cause permanent back pain (P < 0.05), since women with higher education don't believe them. CONCLUSIONS The result of this study proves that, despite the high level of satisfaction with the labor and delivery experience found in our maternity unit, satisfaction remains a complex and dynamic phenomenon.
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Affiliation(s)
| | | | | | - Joana Freitas
- Anesthesiology, Funchal Central Hospital, Funchal, PRT
| | - Jhonny Abreu
- Nursing, Hospital Central do Funchal, Funchal, PRT
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Saxena M, Sharma A, Goyal S, Kothari N. Safety and complications of labour epidural analgesia in obese parturients: worrying is not worth the weight! Anaesthesiol Intensive Ther 2024; 56:17-27. [PMID: 38741440 PMCID: PMC11022643 DOI: 10.5114/ait.2024.138542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/09/2024] [Indexed: 05/16/2024] Open
Abstract
The physiological transformations accompanying pregnancy, compounded by the implications of obesity, pose intricate challenges for anaesthesiologists attending to obese parturients. Obesity makes it harder to successfully provide epidural analgesia to a parturient. This narrative review explains the most recent data on the safety and complications of providing labour epidural analgesia in obese expectant mothers. We have emphasised the evidence-based approaches that are the most effective for obese pregnant mothers receiving labour epidural analgesia.
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Affiliation(s)
| | - Ankur Sharma
- All India Institute of Medical Sciences, Jodhpur, India
| | - Shilpa Goyal
- All India Institute of Medical Sciences, Jodhpur, India
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Jose R, Greenlin L, Isac D, Yadav B, Joselyn AS. Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study. Indian J Anaesth 2023; 67:509-514. [PMID: 37476437 PMCID: PMC10355360 DOI: 10.4103/ija.ija_830_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 07/22/2023] Open
Abstract
Background and Aims Epidural catheter migration is a well-described complication in the obstetric population, though its significance in the non-obstetric surgical population is not known. The purpose of this study was to explore the incidence of epidural catheter migration in a non-obstetric adult surgical cohort, assess the factors associated with migration and analyse complications among patients with and without catheter migration. Methods In this single-centre, prospective, observational study, the acute pain services team collected data over 12 months on consecutive, adult non-obstetric surgical patients who received an epidural catheter for postoperative pain management. Details of epidural catheter insertion, fixation, migration and complications were collected from the first to the fourth postoperative day. Results Of the 510 patients recruited, epidural catheter migration was noted in 233 patients (45.7%), of which 152 (65.2%) migrated outwards and the rest migrated inwards. Also, 72 (30.9%) and 86 (31.05%) complications were noted in the groups with and without catheter migration, respectively. The most frequent complications noted were inadequate analgesia, unilateral sensory block, motor block and hypotension in both groups. We did not find any correlation between the frequency of epidural catheter migration and demographic factors. Conclusions Epidural catheter migration is a sizeable postoperative occurrence in non-obstetric surgical patients. Factors that might play a role in catheter migration could not be established in this study. There is an almost similar frequency of complications noted among patients with and without catheter migration, with the most common being inadequate analgesia in both groups.
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Affiliation(s)
- Riya Jose
- Department of Anaesthesia, Modbury Hospital, South Australia
| | - Latha Greenlin
- Department of Nursing Services, Christian Medical College and Hospital, Vellore,Tamil Nadu, India
| | - Divya Isac
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore,Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College and Hospital, Vellore,Tamil Nadu, India
| | - Anita Shirley Joselyn
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore,Tamil Nadu, India
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Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study. Int J Mol Sci 2023; 24:ijms24043767. [PMID: 36835178 PMCID: PMC9962106 DOI: 10.3390/ijms24043767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the "dystocic pain", that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS.
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El Fawal SM, El Kabarity RH, Ahmed NTF, Abd El Tawab SM. Effect of Epidural Dexmedetomidine vs Nalbuphine for Labor Analgesia:#xd; A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2092300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Grizhimalskiy E, Harha A. Choice of local anesthetic in obstetric anesthesiology: literature review and demonstration of our own experience. PAIN MEDICINE 2022. [DOI: 10.31636/pmjua.v6i4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Regional anesthesia is widely used in obstetric practice, and in many cases is the method of choice. It includes neuroaxial anesthesia (spinal, epidural, combined spinalepidural, epidural with dura mater puncture), regional blocks (eg, TAP block, QL block, ESP block, pudendal block, etc.), as well as local infiltration anesthesia, which is used for both anesthesia and postoperative analgesia. The correct choice of local anesthetic, its dose and concentration is of fundamental importance in obstetric anesthesiology, as it is necessary to ensure the highest quality blockade with minimal side effects on mother and fetus.
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Combined spinal-epidural anesthesia with acupoint injection for labor anesthesia reduces IL-1β/IL-10 ratio in maternal peripheral blood, umbilical cord blood and improves the labor outcomes: A prospective randomized controlled trial. Clin Immunol 2022; 236:108935. [PMID: 35093596 DOI: 10.1016/j.clim.2022.108935] [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: 01/25/2021] [Revised: 11/29/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to investigate the effects of combined spinal-epidural anesthesia (CSEA) with acupoint injection (AI) on the maternal-fetal expression of interleukin-1β (IL-1β), interleukin-10 (IL-10), analgesia effect, and labor outcomes. METHODS A total of 360 healthy primiparas were randomized into the CSEA+AI group, the CSEA group, the AI group, and the control group (n = 90, each group) according to the labor analgesia methods. RESULTS Compared to the CSEA group, the CSEA+AI group had significantly lower visual analog scale (VAS) scores, adverse events, dose of ropivacaine/sufentanil, and shorter labor durations. The IL-1β/IL-10 ratio in maternal peripheral blood and umbilical cord blood was reduced in the CSEA+AI group compared with the CSEA group. CONCLUSION The combination of CSEA and AI can reduce the ratio of IL-1β/ IL-10 in maternal peripheral blood and umbilical cord blood, which can effectively relieve labor pain.
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Puthenveettil N, Hassan A, Nair S, Rajan S, Paul J, Kumar L. Effects of dural puncture epidural technique on onset and duration of labor analgesia: A randomized controlled trial. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chandrashekaraiah M, Koshy L, Hakema S, Ahmed S, Mahammad S, Ibrahim N. Knowledge and awareness of labor analgesia services available in our tertiary hospital among the pregnant women: A prospective study. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_215_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Joseph N, Kumar L, Shyamsundar P, Balakrishnan S, Kesavan R, Rajan S. Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries. Indian J Anaesth 2020; 64:790-795. [PMID: 33162574 PMCID: PMC7641068 DOI: 10.4103/ija.ija_310_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/12/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Epidural analgesia is widely used for pain relief but confirmation of accurate epidural placement is poorly understood. We proposed that sensory blockade to cold sensation would predict the accurate placement of epidural. The primary outcome was the assessment of sensory blockade at 5 and 10 min with a standard epidural test dose versus test dose with additional saline. We looked at haemodynamic changes following administration as secondary outcomes. Methods Following Ethics Committee approval, 161 patients presenting for elective abdominal surgery needing epidural analgesia with general anaesthesia were randomly allocated into Group 1 receiving standard test dose (3 ml of 2% lignocaine with 1:2,00,000 adrenaline) or Group 2 (standard test dose with 6 ml of saline) epidurally. The blockade to cold sensation was assessed at 5 and 10 min. The heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP) were recorded at baseline, 1, 5, and 10 min following epidural dosing. Statistical analysis was performed with Chi-square test for categorical and Student's t-test for continuous variables. Results The sensory blockade at 5 min was 69.5% versus 82.3% (P = 0.059), and at 10 min 85.4% versus 97.5% (P = 0.01) in Groups 1 and 2, respectively. The MAP at 5 min (P = 0.032) and the HR and MAP at 10 min (P = 0.015, 0.04) were significantly lower in Group 2. Conclusion An epidural test dose of 3 ml followed by additional 6 ml saline accurately predicted sensory blockade to cold at 10 min in comparison to the standard dose of 3 ml but was associated with a decrease in the HR and MAP.
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Affiliation(s)
- Nandhini Joseph
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Lakshmi Kumar
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - P Shyamsundar
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sindhu Balakrishnan
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rajesh Kesavan
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sunil Rajan
- Department of Anesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Manouchehrian N, Rabiei S, Moradi A, Lakpur Z. Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial. Anesth Pain Med 2020; 10:e99843. [PMID: 32944556 PMCID: PMC7472646 DOI: 10.5812/aapm.99843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background Labor pain is a severe pain, and intrathecal opioid injection is one of the analgesia methods to reduce it. Objectives We assessed the effects of intrathecal Fentanyl and Sufentanil on the onset, duration, and quality of analgesia for labor analgesia. Methods In this double-blind, randomized clinical trial, 54 healthy nulliparous women 18 - 45 years in the active phase of labor who were requesting labor analgesia were enrolled in two groups fentanyl (F) and sufentanil (S). Patients received 75 µg fentanyl or 7.5 µg sufentanil intrathecally in the fentanyl group (n = 27) and the sufentanil group (n = 27), respectively. Pain relief, onset, duration of analgesia, hemodynamic parameters, patients' satisfaction, and neonatal Apgar score were assessed in this study. Data were analyzed by using SPSS16. Results There were no significant differences between the groups in terms of demographic and hemodynamic parameters. The onset time of analgesia was 5.6 ± 4.3 and 3.6 ± 2.1 minutes, in the sufentanil and fentanyl groups, respectively (P = 0.037). The duration of analgesia was higher in patients who received sufentanil than those who received fentanyl (113 ± 45 vs. 103 ± 22 minutes (P = 0.629)). The pain score in the Fentanyl group was significantly lower at 5, 10, and 15 minutes after spinal analgesia (P < 0.05). The sedation score at 1 and 5 minutes was significantly higher in the fentanyl group than the sufentanil group (P < 0.05). The frequency and severity of pruritus and satisfaction rate in the fentanyl group were significantly higher than the sufentanil group. Conclusions Intrathecal fentanyl and sufentanil have a similar analgesic effect on labor. Fentanyl is associated with a faster onset of analgesia and more satisfaction, while sufentanil has longer analgesia.
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Affiliation(s)
- Nahid Manouchehrian
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding Author: Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences, Pasdaran St, Hamadan, Iran.
| | - Soghra Rabiei
- Department of Obstetrics and Gynecology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Lakpur
- Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
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