International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialCombined spinal epidural anaesthesia for caesarean section: a randomised comparison of Oxford, lateral and sitting positions.
Maternal position during induction of intrathecal anaesthesia for caesarean section influences block height and haemodynamic stability. In a randomised study of 90 women presenting for elective caesarean section using combined spinal-epidural anaesthesia, three positions were compared--the Oxford position (group O), the right lateral to supine wedged (group R) and the sitting to supine wedged (group S). Hyperbaric bupivacaine 12.5 mg with fentanyl 12.5 microg was injected intrathecally using a needle-through-needle CSE technique. ⋯ There were no significant differences in blood pressure although ephedrine requirements were less in group R. There were no significant differences in the incidence of maternal nausea and vomiting or in neonatal outcome as assessed by Apgar scores and umbilical cord blood gas analysis. Although the study failed to show any significant differences in block height between the groups, no women in group O had a block above T2 compared with three in group R and three in group S.
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Int J Obstet Anesth · Jul 2002
Randomized Controlled Trial Clinical TrialHaemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia.
The haemodynamic effects of oxytocin receive scant attention in pharmacology texts, but may be clinically significant in vulnerable patients. Despite prescriber information recommending a dose of 5 international units by slow i.v. injection, it is the authors' experience that it is very common practice in the UK to give 10 units as a rapid injection. We therefore conducted a randomised, double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia. ⋯ This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom. The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis, but no evidence exists to claim that even this will be haemodynamically inert. We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease.
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Int J Obstet Anesth · Apr 2002
Randomized Controlled Trial Clinical TrialHigh-dose diclofenac for postoperative analgesia after elective caesarean section in regional anaesthesia.
Although the use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established in the postoperative setting, their use after caesarean sections is still controversial. In a randomised, double-blinded, placebo controlled study we have estimated the opioid-sparing effect of diclofenac suppositories after elective caesarean sections in spinal anaesthesia. Eighty-two women ASA class I or II scheduled for caesarean section were randomised to receive either diclofenac suppositories 100 mg or placebo every 12 h after the operation. ⋯ The average level of postoperative pain as estimated by a visual analogue scale (VAS) and a verbal scale tended to be lower in the diclofenac group, but this was not significant. There were no differences in demographic data, perioperative bleeding, side-effects or discharge time between the groups. Diclofenac suppositories 100 mg given twice daily after caesarean section are opioid sparing.
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Int J Obstet Anesth · Apr 2002
Randomized Controlled Trial Clinical TrialIntradermal ketorolac for reduction of epidural back pain.
Between 30 and 45% of all parturients receiving epidural laboring analgesia complain of postpartum back pain. Although long-term or chronic back pain has been reported, our study focuses on acute or short-term back pain that resolves within 72 h. The purpose of this randomized double-blind, placebo-controlled investigation was to determine if a ketorolac/lidocaine intradermal anesthesia combination could decrease post-epidural back pain. ⋯ Demographics, mode of delivery and length of labor were similar between groups. Significantly lower verbal numeric scores were noted in the experimental group at the 24-h active measurements after vaginal delivery and at 24 and 72 h for both active and resting measurements after cesarean delivery. Based on these findings it can be recommended that intradermal ketorolac given at the time of epidural catheter placement may result in a reduction in post-epidural back pain in the parturient, especially in the event of cesarean delivery.
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Int J Obstet Anesth · Jul 2001
Randomized Controlled Trial Clinical TrialEffect of lateral versus supine wedged position on development of spinal blockade and hypotension.
Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. ⋯ Following spinal anaesthesia, hypotension (defined as a reading