International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2020
Review Meta AnalysisQuadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis.
Quadratus lumborum block (QLB) can reduce pain and opioid consumption after cesarean delivery. This systematic review investigated the effectiveness of QLB in reducing postoperative opioid use and its effect on pain scores compared with other analgesic methods after cesarean delivery. ⋯ The review findings show the superior analgesic effect of QLB when compared with systemic opioids in reducing postoperative opioid consumption, when intrathecal morphine is not administered.
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Int J Obstet Anesth · May 2020
Randomized Controlled Trial Comparative StudyComparative efficacy of epidural clonidine versus epidural fentanyl for treating breakthrough pain during labor: a randomized double-blind clinical trial.
Breakthrough pain during neuraxial labor analgesia is typically alleviated with additional administration of epidural local anesthetics, with or without adjuvants. Sometimes avoiding neuraxial opioids may be warranted and clonidine is an alternative. In a randomized double-blind trial we compared the efficacy of clonidine versus fentanyl, added to bupivacaine, for the management of breakthrough pain. ⋯ Epidural clonidine 100 μg was not superior to fentanyl 100 μg for decreasing pain scores within 15 min of co-administration with bupivacaine 0.125% for intrapartum breakthrough pain. The analgesic efficacy and hemodynamic side effects did not significantly differ.
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Int J Obstet Anesth · May 2020
ReviewRescue supraglottic airway devices at caesarean delivery: What are the options to consider?
Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. ⋯ However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation. Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.