Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2018
Randomized Controlled Trial Comparative StudyLabor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-Gauge Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial.
Lumbar epidurals (LEs) provide excellent analgesia. Combined spinal epidural and dural puncture epidural (DPE) are 2 techniques to expedite neuraxial analgesia onset. In DPE, dura is punctured but medication is not administered in the cerebrospinal fluid. Expedited analgesia onset has been demonstrated with DPE, using 0.25% bupivacaine; however, this concentration may impede an unassisted vaginal birth and is not currently used for induction and maintenance of labor analgesia. The primary goal of this study was to compare the percentage of patients who achieved adequate labor analgesia following DPE or LE with an epidural bolus of 0.125% bupivacaine. Adequate labor analgesia was defined as Visual Analog Scale (VAS) measurement ≤ 10 mm on a 100-mm scale during active contractions, measured 10 minutes after epidural bolus initiation. ⋯ Although the percentage of parturients achieving adequate labor analgesia at 10 minutes after epidural bolus did not differ by technique, DPE was associated with faster time to VAS ≤ 10 mm compared with LE.
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Anesthesia and analgesia · Feb 2018
Randomized Controlled TrialEpidural Space Identification With Loss of Resistance Technique for Epidural Analgesia During Labor: A Randomized Controlled Study Using Air or Saline-New Arguments for an Old Controversy.
The best technique to identify the epidural space for labor analgesia is still unclear despite the publication of various randomized controlled studies and meta-analyses. Our aim was to assess the superiority of the saline loss of resistance (SLOR) technique over the air loss of resistance (ALOR) technique with respect to the quality of the block. ⋯ Pain score reduction after 30 minutes and onset of the block were not affected by the technique used to locate the epidural space.
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Anesthesia and analgesia · Feb 2018
Randomized Controlled TrialAlkalinized Lidocaine Preloaded Endotracheal Tube Cuffs Reduce Emergence Cough After Brief Surgery: A Prospective Randomized Trial.
Alkalinized lidocaine in the endotracheal tube (ETT) cuff decreases the incidence of cough and throat pain on emergence after surgery lasting more than 2 hours. However, alkalinized lidocaine needs 60-120 minutes to cross the ETT cuff membrane; therefore, its usefulness in shorter duration surgery is unknown. This prospective double-blind randomized controlled trial tested the hypothesis that alkalinized lidocaine would reduce the incidence of emergence cough after surgeries lasting <120 minutes. ⋯ Alkalinized lidocaine in the ETT cuff significantly decreased general anesthesia emergence cough after surgeries with an average duration of slightly <1 hour.
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Anesthesia and analgesia · Feb 2018
Randomized Controlled Trial Comparative StudyRandomized Controlled Trial of the Clinical Efficacy of Multiport Versus Uniport Wire-Reinforced Flexible Catheters for Labor Epidural Analgesia.
The purpose of this prospective, randomized, controlled trial was to determine whether multiple ports improve the analgesic efficacy of wire-reinforced flexible catheters used for labor epidural analgesia (LEA). ⋯ Multiple ports do not appear to improve the analgesic efficacy of wire-reinforced flexible catheters used for LEA.