Current opinion in anaesthesiology
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Although millions of parturients profit from neuraxial analgesia for labor, there are far more of those who do not have this choice for one reason or another. They need alternative ways to relieve labor pain. ⋯ Paracervical block with modern technique is a viable option for selected cases. It is rapid and does not affect the course of labor, but its efficacy is only modest. Pudendal block can be used in the second stage of labor or for episiotomy tear repair and pain. Intravenous remifentanil is currently becoming an established method, although its safety is still an issue. Nitrous oxide is a useful method to be used alone or together with the other methods.
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Curr Opin Anaesthesiol · Jun 2011
ReviewMaternal haemodynamic changes during spinal anaesthesia for caesarean section.
Maternal haemodynamic changes during spinal anaesthesia for caesarean section have traditionally been evaluated by noninvasive blood pressure and heart rate. Recent publications have addressed the importance of cardiac output measurement in the assessment of the maternal circulation. In this review, a physiological approach is suggested for the prevention and treatment of haemodynamic instability during caesarean section in healthy women and in those with preeclampsia or cardiac disease. ⋯ The most frequent response to spinal anaesthesia for elective caesarean section is a marked decrease in systemic vascular resistance and partial compensation from increased stroke volume and heart rate. Early administration of phenylephrine by bolus or continuous infusion is indicated in most cases. Recent work has expanded our knowledge of the therapeutic range of phenylephrine and indicates that the heart rate response to vasopressors is a good surrogate marker for cardiac output. Further research should examine haemodynamic changes during spinal anaesthesia in high-risk pregnant women with early onset preeclampsia or cardiac disease.
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This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. ⋯ The concept of preventive analgesia is still an attractive working hypothesis but with inconclusive results. A plea for better design of clinical studies is forwarded.