International journal of obstetric anesthesia
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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).
pearl -
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).
pearl -
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
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
ReviewPost-caesarean delivery analgesia in resource-limited settings: a narrative review.
Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. ⋯ Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.