International journal of obstetric anesthesia
-
Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of intermittent epidural bolus, continuous epidural infusion and patient controlled-epidural analgesia during labor.
The aim of the study was to compare efficacy and side-effects produced by three techniques of epidural analgesia during labor: intermittent bolus (1B), continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA). One hundred and fifty parturients allocated randomly to three groups received the same epidural solution of bupivacaine 0.125% with sufentanil 0.5 microg/mL. In the first group (IB: n=50) boluses were administered by the anesthesiologist and titrated to achieve adequate analgesia. ⋯ The other side-effects were equally distributed in the three groups. We concluded that PCEA with bupivacaine and sufentanil is a valuable technique and a good alternative to the IB method. Compared to the CEI technique, PCEA allows a decrease in local anesthetic consumption without impairing the quality of anesthesia.
-
Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialOxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section.
A novel positioning technique was tested to see whether the unpredictability of block height and haemodynamic instability during spinal anaesthesia for caesarean section could be reduced. In this 'Oxford' position, the woman is placed left lateral with an inflated bag under the shoulder and pillows supporting the head. Following spinal injection the woman is turned to an identical right lateral position. ⋯ Block height was more variable in group S than in group O (f test, P = 0.001). Blood pressure decreased by a greater amount initially: group S women required more ephedrine (15.5 +/- 12.9 versus 9.2 +/- 7.7 mg, t test, P = 0.03). Block height with spinal anaesthesia for caesarean section is more predictable and haemodynamically stable if the Oxford position is used whilst anaesthesia develops.
-
Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialDose response study of subarachnoid diamorphine for analgesia after elective caesarean section.
Subarachnoid diamorphine provides excellent analgesia after elective caesarean section but the optimum dose is still uncertain. We therefore investigated the effects of three regimens of subarachnoid diamorphine. Forty parturients were assigned to one of four groups. ⋯ The mean (SD) dose of PCA morphine used over 24 h was 39.4 (14.7), 25.6 (16.5), 21.6 (15.9) and 3.1 (3.6) mg, and mean time to first use of morphine was 1.6 (0.5), 3.0 (1.4), 3.4 (2.4) and 14.1 (9.4) h, in the 0, 0.1 mg, 0.2 mg and 0.3 mg groups respectively. Side-effects of pruritus, nausea and vomiting were dependent on the dose of spinal diamorphine but did not require treatment in any patients. We conclude that 0.3 mg subarachnoid diamorphine provides significantly better postoperative pain relief than the smaller doses with an acceptable increase in side-effects.