International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2019
Observational StudyLabor epidural analgesia onset time and subsequent analgesic requirements: a prospective observational single-center cohort study.
We investigated the correlation between lumbar epidural analgesia onset time and pain intensity at 60 and 120 min after initiation. ⋯ There was a correlation between the onset time of lumbar epidural analgesia during labor and the pain score 60 min later but this had disappeared by 120 min.
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Int J Obstet Anesth · Nov 2019
Review Meta AnalysisInduction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials.
Remifentanil and alfentanil effectively reduce the pressor response to intubation for general anaesthesia cesarean section, without depressing neonatal Apgar scores.
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Int J Obstet Anesth · Nov 2019
Review Meta AnalysisDifficult epidural placement in obese and non-obese pregnant women - A systematic review and meta-analysis.
Maternal obesity increases the risk of epidural failure (OR 1.8) and difficult insertion requiring multiple attempts (OR 2.2).
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Int J Obstet Anesth · Nov 2019
ReviewDural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials.
Dural puncture epidural (DPE) analgesia is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a medication being injected intrathecally. There have been contradictory findings regarding better analgesia and better block quality. ⋯ There is a lack of clear evidence on either the benefits or therisks of the DPE technique, such that a recommendation for or against its routine use is premature. Two of the three studies showing a beneficial effect of DPE came from the same institution and replication of the findings by other groups is warranted.
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Int J Obstet Anesth · Nov 2019
ReviewLocal anaesthetic techniques for post-caesarean delivery analgesia.
In this narrative review we summarise pertinent data from published studies investigating the use of local anaesthetic techniques as adjuncts for managing post-caesarean delivery pain. Based on currently available evidence, ultrasound-guided transversus abdominis plane (TAP), quadratus lumborum (QL) and ilio-inguinal and iliohypogastric (ILIH) blocks are preferable to landmark techniques. When intrathecal morphine is used for caesarean delivery analgesia, TAP blocks do not confer any additional benefit. ⋯ Quadratus lumborum and ILIH blocks show promising results but the data are limited, so recommendations for routine use cannot be made. In summary, evidence supports the use of local anaesthetic techniques for post-caesarean delivery pain but additional research is required to determine the optimum dosing regimens, and the potential role of liposomal local anaesthetics. Further studies are required to compare techniques and determine their role in conjunction with low-dose long-acting neuraxial opioids.