International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1993
Double-blind evaluation of patient-controlled epidural analgesia during labor.
A double-blind randomized study was designed to compare the efficacy of patient-controlled epidural analgesia (PCEA) with continuous epidural analgesia (CEA) with regards to patient satisfaction with analgesia, analgesic efficacy, and local anesthetic usage. After establishing effective epidural analgesia with 8 ml of 0.25% bupivacaine, 39 parturients were randomized to 1 of 2 groups. The CEA group received a continuous infusion of 12 ml/h of 0.125% bupivacaine. ⋯ The 2 groups also did not differ significantly in terms of patient satisfaction, pain assessment, or total drug usage. However, the PCEA group required significantly fewer supplemental doses (15%) compared with the CEA group (40%). The decreased need for supplemental doses in the PCEA group may suggest a potential advantage in consistency of analgesia and possibly decreased man-power needs.
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Int J Obstet Anesth · Jan 1993
Anaesthetic technique for elective caesarean section and neurobehavioural status of newborns.
Ninety healthy parturients undergoing elective caesarean section were randomly allocated to receive either general (n = 30), epidural (n = 30) or spinal (n = 30) anaesthesia. Acid-base status, Apgar score and neurobehavioural status, using the neurologic and adaptive capacity scoring (NACS) system, were studied in the newborn. ⋯ NACS testing revealed significantly more vigorous babies in the spinal anaesthesia group than in the other two groups at 15 min and 2 h interval after delivery, despite a higher incidence of maternal hypotension. We conclude that newborns tend to have a better neurobehavioural status in the early post-delivery period if their mothers receive spinal anaesthesia rather than general or epidural anaesthesia for caesarean section.
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Int J Obstet Anesth · Jan 1993
Is opioid loading necessary before opioid/local anaesthetic epidural infusion? A randomized double-blind study in labour.
The effects of two different epidural loading doses administered before starting an opioid/low dose local anaesthetic infusion were examined in a randomized double-blind study during labour. Forty mothers were given either 10 ml 0.25% plain bupivacaine or 10 ml 0.125% plain bupivacaine containing 5 mcg of sufentanil followed in all cases by epidural infusion of 0.08% plain bupivacaine containing 0.2 mcg/ml of sufentanil, which was continued into the second stage. The quality of analgesia did not differ significantly between the groups in either the first or the second stage of labour: in each group 75% of women required 0 or 1 top-up during labour and verbal numerical pain scores were similar. ⋯ There was no difference in the degree of maternal satisfaction assessed 24 hours after delivery, with 80% of women in each group awarding the maximum verbal numerical score for their satisfaction with epidural analgesia. The incidence of maternal side effects (nausea, vomiting, drowsiness and pruritus) was similar in the 2 groups as was neonatal outcome, assessed by Apgar and neurological and adaptive capacity scores and umbilical artery and vein pH. We conclude that opioid loading before opioid/low-dose bupivacaine epidural infusions is unnecessary.
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Int J Obstet Anesth · Jan 1993
Patient controlled epidural analgesia during labour: choice of solution.
Epidural characteristics, when using different solutions for patient controlled epidural analgesia (PCEA), were compared in a randomised, blinded study in labour. Women in group 1 (n=23) self-administered 0.25% plain bupivacaine, in group 2 (n=23) 0.125% plain bupivacaine plus fentanyl 3 microg/ml and in group 3 (n=20) 0.0625% bupivacaine with adrenaline 1:250,000 plus fentanyl 3 microg/ml. ⋯ The rate of bupivacaine utilisation was significantly higher in group 1 compared to groups 2 and 3 and lower in group 3 compared to 1 and 2 (median+interquartile range: 16+11-21 vs 9+6-11 vs 4+3-8 mg/hr, P<0.0002). Although all solutions provided effective pain relief for PCEA during labour, the use of a low-dose bupivacaine-fentanyl combination offers clinical advantages and further evaluation of such solutions is warranted.
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Int J Obstet Anesth · Jan 1993
Maternal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of fentanyl added to 0.5% bupivacaine improves epidural anaesthesia during caesarean section. The present prospective randomized double-blind study sought to determine the lowest effective dose of fentanyl. Eighty healthy women at term were divided into four groups of 20, with each group receiving a different 2 ml study solution: saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Pruritus was the only side-effect (P < 0.05). In conclusion, fentanyl 75 microg was the lowest effective dose for improving quality of analgesia. Onset time was not reduced by the addition of fentanyl.