Clinics in perinatology
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Clinics in perinatology · Sep 2013
Review Comparative StudyCombined spinal-epidural versus epidural analgesia for labor and delivery.
The rapid onset of analgesia and improved mobility with combined spinal-epidural (CSE) techniques has been associated with a higher degree of maternal satisfaction compared with conventional epidural analgesia. However, controversy exists in that initiation of labor analgesia with a CSE may be associated with an increased risk for nonreassuring fetal status (ie, fetal bradycardia) and a subsequent need for emergent cesarean delivery. Overall, both epidural and CSE techniques possess unique risk/benefit profiles, and the decision to use one technique rather than the other should be determined based on individual patient and clinical circumstances.
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Accurate pain assessment in preterm and term neonates in the neonatal intensive care unit (NICU) is of vital importance because of the high prevalence of painful experiences in this population, including both daily procedural pain and postoperative pain. Over 40 tools have been developed to assess pain in neonates, and each NICU should choose a limited number of pain assessment tools for different populations and contexts. ⋯ Preterm neonates do not display behavior and physiologic indicators of pain as reliably and specifically as full term infants, and preterm infants are vulnerable to long term sequelae of painful experiences. "Brain-oriented" approaches for more objective measurement of pain in neonates may become available in the future. In the meantime, neonatal pain assessment tools need to be taught, implemented, and their ongoing use optimized to form a consistent, reproducible basis for the safe and effective treatment of neonatal pain.
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This article describes the anesthetic management of pregnant women undergoing fetal surgery. Discussion includes general principles common to all fetal surgeries as well as specifics pertaining to open fetal surgery, minimally invasive fetal surgery, and ex utero intrapartum therapy (EXIT) procedures.
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Clinics in perinatology · Sep 2013
ReviewNonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations.
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. ⋯ Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.
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Cesarean deliveries can be associated with moderate to severe postoperative pain. Appropriate management of pain is important because it results in better patient satisfaction, earlier mobilization, and improved maternal-infant bonding. There are many individual options for treatment of pain; however, multimodal analgesic therapy has become the mainstay of treatment. In this article, the epidemiology of postcesarean delivery pain, pain mechanisms, and the multiple options available to providers for treatment of postoperative pain are discussed.