Severe back labor pain masks a scald caused by shower hydrotherapy: a case report

Shower hydrotherapy is generally considered benign during labor. We report a case of extensive scalds in a primigravida who used shower hydrotherapy to treat severe back labor pain from fetal malposition. Interestingly, her back pain was so severe that she felt no pain as her scald developed, describing the hot water from the showerhead as the only measure which "soothed" her pain. Her scald was diagnosed presumptively during assessment for epidural analgesia. The nature of her back labor pain, associated with occiput posterior fetal head position and her management are described. Severe pain from persistent fetal malposition may alter somatic pain perception during labor, increasing burn risks during shower hydrotherapy. These women are also at increased risk of operative delivery and infection risks from inadvertent neuraxial blockade after burns. Improved prevention strategies and vigilance for scalds are warranted in women with severe back labor undergoing shower hydrotherapy, including by anesthesiologists assessing them for neuraxial blockade.

Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective

BACKGROUND

Advances in vitrification techniques have enabled planned oocyte cryopreservation ('Planned OC').

OBJECTIVES

To explore the cost-efficiency and utilisation of planned OC, as well as patients' perspectives on the process.

SEARCH STRATEGY

A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019.

SELECTION CRITERIA

The protocol followed PRISMA guidelines in PECO format, and was registered with PROSPERO.

DATA COLLECTION AND ANALYSIS

Two independent reviewers evaluated all manuscripts for inclusion eligibility. Authors were contacted for missing data. Included studies were assessed for risk of bias and for heterogeneity. Weighted effects were measured and plotted.

MAIN RESULTS

The search yielded 12 545 records, of which 43 were included. Planned OC is cost-efficient at 35, assuming 60% utilisation; and at 37 assuming utilising donor sperm when necessary. At 38 it is cost-efficient to defer planned OC in favour of undergoing 2 IVF cycles. Currently, utilisation of banked-oocytes within 22-58 months, is up to 15%. Nine percent of warmed banked oocytes result in life births. Online resources and treating physicians are equally important sources of information regarding planned OC. Most patients think planned OC is ideal before age 35 and are not fully aware of what the process entails and tend to overestimate the success rates. The main barrier to wider endorsement of planned OC is being wary of potential health implications or of limited success.

CONCLUSION

Planned OC is an adequate method for preserving fertility. However, knowledge gaps result in under-utilisation leading to reduced cost-efficiency.

TWEETABLE ABSTRACT

Identifying facilitators and barriers for wider adoption of banking oocytes can enhance the cost-efficiency of this modality.

Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation

OBJECTIVES

Postoperative stump pain after major lower limb amputation is a significant impediment to the recovery of amputees. The vast majority of patients require opioid analgesics following surgery, which are associated with opioid-related side-effects. Here, we investigate whether intraoperative placement of a peripheral nerve stump catheter followed by continuous infusion of local anesthetic is as effective at pain control as current analgesic practices. If beneficial, this procedure could potentially reduce post-amputation opioid consumption and opioid-related adverse effects.

METHODS

A retrospective chart review was conducted of 198 patients over a 4-year period who had undergone a major lower limb amputation for indications related to peripheral vascular disease. Postoperatively, 102 patients received a perineural catheter were compared to 96 patients who did not. The primary outcomes of this study were the amount of morphine equivalents used in the first 72 hours postoperatively and postoperative pain intensity in the first 24 hours.

RESULTS

A total of 198 lower-limb amputations were selected for analyses. Multiple regression analyses indicated that perineural catheter use was associated with a lower cumulative postoperative opioid consumption over the first 72 hours but not postoperative pain scores at 24 hours. Perineural catheter use led to a 40% reduction in opioid use during the first 72 hours postoperatively. Mixed model repeated measures analysis demonstrated that this opioid reduction was consistent over time. Other variables related to total opioid use included age, pre-surgical chronic pain, pre-surgical opioid use, patient-controlled analgesia.

CONCLUSIONS

Continuous perineural infusions of local anesthetic are a safe and effective method for reducing post-amputation opioid analgesic medications after major lower limp amputation.