International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2006
ReviewA survey of labor patient-controlled epidural anesthesia practice in California hospitals.
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals. ⋯ Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.
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Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialPatient-controlled epidural analgesia: the role of epidural fentanyl in peripartum urinary retention.
Urinary bladder function is impaired during labor and delivery, predisposing to urinary retention. The effect of low-dose epidural opioid on bladder function remains unclear. We tested the hypothesis that adding low-dose fentanyl to epidural ropivacaine for patient-controlled labor analgesia does not promote urinary retention. ⋯ Addition of fentanyl to patient-controlled epidural analgesia did not increase the risk of urinary retention. Ultrasound measurements were effective and reliable in assessing urinary bladder volumes during labor.
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Int J Obstet Anesth · Jul 2006
Randomized Controlled TrialIncisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study.
This study evaluated efficacy, safety and patient satisfaction with incisional analgesia with a subfascial catheter compared to epidural analgesia for pain relief following caesarean section. ⋯ Incisional local analgesia via a subfascial catheter provided satisfactory pain relief with patient satisfaction comparable to that seen with epidural analgesia. This technique may be a good alternative to the more invasive epidural technique following caesarean section as a component of multimodal pain management.
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Int J Obstet Anesth · Jul 2006
An analysis of the need for anesthetic interventions with differing concentrations of labor epidural bupivacaine: an observational study.
Labor epidural analgesia techniques using lower concentrations of bupivacaine are designed to maintain pain control with fewer side effects such as hypotension and motor block. However, the increase in sensation may allow breakthrough pain resulting in the need for additional interventions. We examined the number of interventions, both for analgesia and for treatment of side effects, required when using three concentrations of bupivacaine. ⋯ Neither the total interventions nor intervention rate per hour varied significantly with the concentrations of bupivacaine used in this study. Lower concentrations produced fewer side effects including hypotension, while the higher concentration resulted in less breakthrough pain.
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Int J Obstet Anesth · Jul 2006
Case ReportsPneumocephalus with headache complicating labour epidural analgesia: should we still be using air?
Pneumocephalus is a rare complication of epidural block which typically occurs when the loss of resistance to air technique is used to identify the epidural space. We present a case of pneumocephalus with headache in a parturient following apparently uncomplicated labour epidural analgesia.