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'Labor and Delivery Analgesia Regional and Local' (53)


Jul
2017

Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia.
A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement.

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May
2017

There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly.

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Dec
2016

Various degrees of left ventricular outflow tract (LVOT) obstruction have been seen in patients with subvalvular aortic stenosis (SAS). Regional analgesia during labor for parturients with SAS is relatively contraindicated because it has a potential risk for hemodynamic instability due to sympathetic blockade as a result of vasodilation by local anesthetics. We thought continuous spinal analgesia (CSA) using an opioid and minimal doses of local anesthetic could provide more stable hemodynamic status.

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Dec
1969

Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1-L2 space, followed by an intravenous administration of ketamine (0.

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Jun
2015

Successful external cephalic version (ECV) for breech presenting fetus reduces the need for Caesarean section (CS). We aimed to compare the success rate of ECV with either spinal anaesthesia (SA) or i.v.

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Jun
2015

The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic.
In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT).

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Mar
2015

The objective of this study is to investigate the relationship between epidural analgesia (EDA) in labor and the onset of lactation in healthy women after birth. In a Regional Perinatal Center in northern Italy, women who had had a vaginal delivery were recruited by convenience sampling. Analyses were carried out on the data of 366 women.

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Jan
2014

Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women, and is becoming the leading cause of maternal death in U.S.A and U.

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Oct
2014

Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia.

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Jul
2012

Analgesia in Obstetrics.

Geburtshilfe Frauenheilkd 2012 Jul;72(7):596-601
M Heesen, M Veeser
An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients.

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Mar
2012

Labor analgesia.

Am Fam Physician 2012 Mar;85(5):447-54
Steven D Schrock, Carolyn Harraway-Smith
Regional analgesia has become the most common method of pain relief used during labor in the United States. Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space, and the patient receives a continuous infusion or multiple injections of local anesthetic.

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Mar
2012

Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only.

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Dec
2011

Epidural versus non-epidural or no analgesia in labour.

Cochrane Database Syst Rev 2011 Dec 7(12):CD000331. Epub 2011 Dec 7.
Millicent Anim-Somuah, Rebecca Md Smyth, Leanne Jones
Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant.
To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour.

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Jun
2011

Maternal ambulation during labor.

Curr Opin Anaesthesiol 2011 Jun;24(3):268-73
Adrienne Stewart, Roshan Fernando
To describe the recent advances in labor epidural analgesia, which may have an impact on maternal ambulation during labor.
With the advent of new epidural adjuvant drugs and new epidural delivery systems, we are now able to use very low concentration local anesthetic solutions with a reduction in the total doses of local anesthetic administered. This allows a much greater preservation of lower limb motor function in the parturient, with a subsequent positive effect on maternal ambulation.

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Dec
1969

We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature.

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Aug
2010

Advances in labor analgesia.

Int J Womens Health 2010 Aug 9;1:139-54. Epub 2010 Aug 9.
Cynthia A Wong
The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum.

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Mar
2008

Assessing the quality of anaesthesia records according to the criteria of the reference frame of professional practices evaluation proposed by the French Anaesthetists College (Cfar) in 2005.
Retrospective, multicentric study.
Fifty anaesthesia records were randomly selected from each of the 64 health care settings in Aquitaine with an inpatient surgery activity.

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Mar
2008

[Anaesthesia, a cause of fetal distress?].

Ann Fr Anesth Reanim 2007 Jul-Aug;26(7-8):694-8. Epub 2007 Jun 14.
M-P Bonnet, M Bruyère, M Moufouki, A De la Dorie, D Benhamou
To describe the effects of anaesthetic techniques and agents on the risk of fetal distress during labour pain relief and anaesthesia for caesarean section.
Data on obstetric anaesthesia- and analgesia-induced fetal distress were searched in Medline database using MESH terms: fetal distress, anaesthesia, analgesia, labour, caesarean section, and umbilical artery pH. Trials published in English or French language were selected.

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Jun
2007

To report the favourable outcome associated with epidural analgesia in a parturient with spinocerebellar ataxia (SCA).
A 34-yr-old patient, G2 P0, presented at term with a history of SCA since the age of 22 characterized by slurred speech, balance and gait disturbances, diplopia and nystagmus. A magnetic resonance imaging of the brain at the age of 27 showed cerebellar degeneration.

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May
2007

[Combined spinal-epidural anaesthesia for pain relief in obstetric patients].

Anasthesiol Intensivmed Notfallmed Schmerzther 2007 May;42(5):342-9
Thomas Standl
Besides epidural analgesia combined spinal-epidural anaesthesia (CSE) is one of the favourite techniques of regional anaesthesia for pain relief in obstetric patients. CSE combines the advantage of spinal anaesthesia, e.g.

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Jul
2007

The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia.
Forty ASA I parturients at 37-42 weeks' gestation and cervical dilatation <6 cm were randomly allocated to receive either epidural analgesia (group EA) or combined spinal-epidural analgesia (group CSEA). Analgesia was initiated with a 7-mL epidural bolus 0.

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May
2006

To describe the impact of maternal automatic implantable cardioverter-defibrillator (AICD) therapy on pregnancy outcome, and discuss the clinical rationale for regional anesthesia in parturients with AICDs.
A 20-yr-old primigravida with a history of familial cardiomyopathy and AICD placement presented at 39 weeks gestational age for elective labour induction. Ultimately, the patient underwent a Cesarean section for a failed induction.

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Apr
2006

There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis.
Following Obstetric Anaesthetists' Association approval a questionnaire was sent to UK consultant members.

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Mar
2006

The use of regional anesthesia for elective Cesarean section has been demonstrated to be safe for both the mother and new-born. In parturients with an epidural catheter placed previously for labor analgesia, extension of the epidural block may be the preferred option, provided that adequate speed of onset and adequate surgical anesthesia are obtained. We therefore performed a prospective, randomized, double-blind trial to examine the speed of onset and anesthetic quality of 2-chloroprocaine vs.

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Feb
2006

The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0.

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Oct
2005

Epidural versus non-epidural or no analgesia in labour.

Cochrane Database Syst Rev 2005 Oct 19(4):CD000331. Epub 2005 Oct 19.
M Anim-Somuah, R Smyth, C Howell
Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant.
To assess the effects of all modalities of epidural analgesia (including combined -spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour.

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Apr
2003

Pregnant patients may give a history of allergy to local anaesthetics, but many of these supposed allergies have not been investigated. There is cross-reactivity between the amide local anaesthetics, which are the only group available in the UK for regional analgesia. We report the management of a primigravida who gave a history of allergy to two local anaesthetics, lidocaine and prilocaine.

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May
2004

To study the reciprocal interferences between pregnancy and myasthenia gravis (MG) and to describe obstetric and anaesthetic management during labour and the post-partum period.
Retrospective, single centre study.
The files of 10 patients with MG, who delivered between October 1994 and May 2002, were examined.

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Dec
2002

Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving anesthesia for cesarean sections in the operating room. Over the last years the treatment of labor pain with epidural anesthesia has been modified. Whereas a couple of years ago local anesthetics were used almost exclusively, the recent trend goes toward a combination of local anesthetics with opioids.

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Dec
2002

Peripartum care of parturients has contributed a great deal to the development of modern anaesthesia during the past 150 years. The introduction of general and regional anaesthesia provided new options of relieving pain during delivery and preventing suffering. However,provision of effective labor analgesia gave and still gives rise to controversy as to whether interfering with natural events such as delivery was justifiable on a religious,moral or ideological level.

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May
2002

A 28-year-old woman, G3P3, who was otherwise healthy and had taken no medication and had no known allergy, was admitted to our hospital for delivery after a normal pregnancy. An epidural catheter was inserted for analgesia and labour was induced with oxytocin. Two hours later, she suffered a sudden cardiac arrest.

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Mar
2002

Induction of labor under analgesia was planned for a 30-year-old-primiparous patient with hypertrophic obstructive cardiomyopathy (HOCM), as her fetal evaluation revealed intrauterine growth restriction at 38 weeks' gestation. However, regional analgesia during labor may present a potential risk for hemodynamic instability in patients with HOCM due to the possibility of a sympathetic block, as a result of vasodilation associated with the administration of local anesthesia. This case report demonstrates the successful management of the patient with analgesia provided by a continuous spinal catheter dosed with a continuous infusion of fentanyl and supplemental meperidine.

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Oct
2000

Patients with Noonan's syndrome present a multiplicity of challenges to the anaesthetist, particularly with regard to cardiovascular, spinal, and airway abnormalities. Anaesthetist may have to deal with an increasing number of these patients presenting to anaesthesia departments requesting analgesia and anaesthesia for surgery of labour. Early detection and planing between obstetricians, midwives and anaesthetists will help successful management of these patients.

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Jan
2001

[Pain relief for vaginal delivery--an overview].

Anasthesiol Intensivmed Notfallmed Schmerzther 2001 Jan;36(1):49-53
G Fiedler
The multimodal aspects of labour pain, it's origin and effects, as well as the possibilities of it's treatment will be described from the obstetrician's point of view. This will include a comparison of methods in current common use during delivery including psychosomatic methods, physical methods, acupuncture, homeopathy, use of water, drug therapy as well as the use of local and regional anaesthesia. For particular discussion is the use of epidural catheter in delivery, with respect to availability, optimal timing and obtaining informed consent and it's documentation, as well as teamwork and clear interdisciplinary decisions concerning frequency and parameters of monitoring for epidural catheter anaesthesia following the motto: "how much is necessary, how little is possible?"

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Jun
2000

The combined spinal-epidural technique.

Anesthesiol Clin North America 2000 Jun;18(2):267-95
N Rawal, B Holmström, J A Crowhurst, A Van Zundert
Epidural and spinal blocks are well-accepted regional techniques, but they have several disadvantages. The CSE technique can reduce or eliminate the risks of these disadvantages. CSE block combines the rapidity, density, and reliability of the subarachnoid block with the flexibility of continuous epidural block to extend duration of analgesia.

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Jan
1999

[Anesthesia and delivery].

Rev Prat 1999 Jan;49(2):167-71
J Seebacher, P Malassiné
Close collaboration of an informed anaesthetist with the obstetrician, and respect of the security protocols in every anaesthesia must guarantee the well-being of pregnant women. The development of loco-regional anaesthesia for use in labour analgesia and caesarean section has reduced the indications and the mortality related to general anaesthesia. In the last 30 years, analgesia and control of loco-regional anaesthesia effects have been greatly improved.

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Sep
1998

Obviously there is a world-wide trend towards regional analgesia for pain relief during delivery. Data on the current practice in Germany are lacking.
In 1996 questionnaires on obstetric anaesthesia and analgesia were mailed to all university departments of anaesthesia.

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Apr
1998

[Obstetric analgesia in Norwegian hospitals].

Tidsskr Nor Laegeforen 1998 Apr;118(11):1693-6
V Dahl, I E Hagen, J C Raeder
We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%.

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Apr
1998

Walking after regional blockade for labour using low-dose combinations of bupivacaine and fentanyl is possible due to the maintenance of lower limb motor power. In order to investigate concerns that dorsal column function, important in maintaining balance, is impaired after such techniques, clinical assessment of lower limb proprioception and vibration sense was evaluated in parturients after either low-dose epidural (n = 30) or spinal blockade (n = 30) for labour analgesia and compared with spinal anaesthesia (n = 30) for elective Caesarean section using a larger total dose of local anaesthetic. Of the patients receiving low-dose regional labour analgesia 7% (n = 4) had abnormal dorsal column function compared with 97% (n = 29) receiving spinal anaesthesia for Caesarean section (p < 0.

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Aug
1997

Regional anesthesia is a popular form of pain relief for the management of labor and delivery. Thrombocytopenia is considered a relative contraindication to the administration of regional anesthesia. Some authorities have recommended that an epidural anesthetic be withheld if the platelet count is <100,000 mm(-3).

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Jun
1997

To investigate current concerns that potent opioid drugs, such as fentanyl, used for labour regional analgesia may affect neonatal status, maternal and umbilical plasma concentrations of fentanyl and bupivacaine at delivery were measured in 40 nulliparous patients receiving low-dose combined spinal epidural analgesia. Neonatal assessments included Apgar scores, umbilical blood gases and neurobehavioural tests. All maternal and umbilical venous plasma concentrations were low.

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Apr
1996

We describe the anaesthetic management for Caesarean section in a parturient with a defect in complex III of the respiratory chain who had increased lactate concentrations at rest and with exercise.
We administered effective epidural anaesthesia with lidocaine for Caesarean delivery. The serum lactate concentration was less than the preoperative value both during and after surgery.

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Dec
1969

Despite of a chronic volume overload the left ventricle function of pregnant women is preserved by both afterload reduction (arterial vasodilatation) and a facilitation of heart filling through an increase in peripheral venous tone. Fetal oxygenation results from an equilibrium between placental and umbilical blood flows. During regional anaesthesia the sympathetic blockade leads to a peripheral vasodilatation (mainly in the capacitive territories) which is the cause of arterial hypotension through a decrease in cardiac output.

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Dec
1969

A case is described of a 30-year-old insulin-dependent diabetic woman who presented at 25 weeks gestation with frontal headache. Contrast tomography revealed an aneurysm of the middle cerebral artery with no evidence of subarachnoid bleeding. Although elective caesarean section at term was planned, it was performed at gestational week 38 due to the onset of vaginal bleeding and premature labour.

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Dec
1969

Epidural and spinal administration of opioids in obstetrics can be used during labour and for cesarean section. Although these routes of administration are of limited use when opiates are employed as sole agents, the association with local anesthetics may improve the characteristics of analgesia. The administration of a local anesthetic-opiate mixture allows a reduction of the total amount of local anesthetics, thus reducing the incidence of maternal hypotension and the percentage of instrumental extraction.

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Aug
1990

Many anesthesiologists prefer epidural anesthesia for cesarean section because of the potential risks of general anesthesia such as Mendelson's syndrome. For this indication, the local anesthetic of first choice is the long-acting substance bupivacaine. The aim of the following study was to determine maternal and neonatal plasma concentrations of bupivacaine 0.

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Dec
1969

Sufficient placental blood flow is mandatory for the well-being of the fetus. The delicate balance between uterine perfusion pressure and uterine vascular resistance can be critically disturbed during epidural anaesthesia. Maternal hypotension is common when extensive block for Caesarean Section is used.

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Feb
1982

Obstetric anesthesia, why?

Clin Perinatol 1982 Feb;9(1):215-24
B B Gutsche

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Aug
1981

Prescribing in pregnancy. Analgesia and anaesthesia.

Clin Obstet Gynaecol 1981 Aug;8(2):475-506
B W Perriss

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