International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1999
Randomized Controlled Trial Clinical TrialBupivacaine 2.5 mg/ml versus bupivacaine 0.625 mg/ml and sufentanil l microg/ml with or without epinephrine 1 microg/ml for epidural analgesia in labour.
We have compared three different methods of epidural analgesia in labour, bupivacaine 2.5 mg/ml (group B), bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml (group BS) and bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml + epinephrine 1 microg/ml (group BSE). One hundred and forty parturients with a singleton fetus with cephalic presentation were randomly allocated to one of the three groups. Group BSE had significantly less pain than groups B and BS. ⋯ All women were highly satisfied with the method of analgesia and 97% would prefer the same kind of pain alleviation at the next delivery. We conclude that epidural analgesia with low-dose bupivacaine and sufentanil is as good an analgesic method as high-dose bupivacaine. Addition of low-dose epinephrine improves the analgesia.
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Int J Obstet Anesth · Jul 1999
A patient who was found to be pregnant unexpectedly during hysteromyomectomy.
We present a case of an unexpected pregnancy and an ultimately successful obstetric outcome. The patient underwent abdominal myomectomy under spinal anaesthesia for a uterine leiomyoma with menorrhagia and infertility. ⋯ The blastocyst survived the surgical manipulation and anaesthesia, resulting in a successful pregnancy. The literature on the endocrinological stress response during anaesthesia and surgery suggests that spinal anaesthesia administered in this case was potentially helpful in maintaining progesterone levels and avoiding increased prolactin levels; increased prolactin levels might be deleterious to implantation of the blastocyst.