International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2000
Randomized Controlled Trial Clinical TrialThe effect of prophylactic glycopyrrolate on maternal haemodynamics following spinal anaesthesia for elective caesarean section.
We conducted a randomised controlled trial to compare the severity of hypotension and ephedrine requirements following spinal anaesthesia for elective caesarean section in women pretreated with either i.v. glycopyrrolate 4.0 microg/kg (group G) or saline (group S). Data were analysed using sequential analysis which allowed us to terminate the study after data from 40 patients had been analysed (20 in each group). ⋯ Intra-operative heart rate increased by a greater amount in group G than in group S (58 +/- 26% vs 35 +/- 21% mean +/- SD;P = 0.002) and there was a greater incidence of dry mouth (75% vs 15%;P = 0.0006) but no difference in the incidence of nausea and vomiting (30% vs 50%;P = 0.33). Pretreatment with glycopyrrolate did not confer an advantage in this study.
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Int J Obstet Anesth · Apr 2000
Randomized Controlled Trial Clinical TrialEffect of epidural clonidine added to epidural sufentanil for labor pain management.
Labor analgesia with intrathecal sufentanil has been shown to be prolonged by the addition of intrathecal clonidine. The current study was designed to determine if epidural clonidine would prolong labor analgesia provided by epidural sufentanil. Forty laboring primiparous women at less than 5 cm cervical dilation requesting epidural analgesia were enrolled. ⋯ Side-effects were similar between the two groups. There was no difference between the two groups in time from sufentanil administration to delivery, incidence of operative or assisted delivery, or cervical dilation at the time of redose. For early laboring patients, epidural sufentanil 20 microg after a lidocaine test dose provides analgesia comparable to that of sufentanil 20 microg with clonidine 75 microg; there was no significant difference in analgesic duration between the two groups.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.
A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. ⋯ The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.
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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.
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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.