International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1999
Are women requiring unplanned intrapartum epidural analgesia different in a low-risk population?
We studied 645 full-term low-risk women in early labour in 6 units to evaluate the effects of maternal characteristics and obstetric management in early labour on the use of epidural analgesia, and to analyse the relationship between epidural analgesia, progress of labour and mode of delivery using multiple logistic regression. Among variables present in early labour, nulliparity, ethnicity and obstetric unit were the strongest predictors of epidural analgesia requirement. In nulliparous women, obstetric unit affected use of epidural analgesia (P<0.05) and induction of labour was associated with increased use of epidural analgesia (odds ratio 3.45, 95% CI: 1.45-7.90). ⋯ Furthermore, rate of cervical dilation was similar in the non epidural group throughout the first stage (mean 3.41 cm/h, 95%CI: 3.19-3.63) and in the epidural group after epidural analgesia decision (mean 3.99, 95% CI: 2.96-5.02), while the mean cervical dilatation rate before epidural analgesia was 0.88 cm/h (95% CI: 0.72-1.04). The need for epidural analgesia is, therefore, multifactorial and difficult to predict. Whereas nulliparity increases epidural analgesia requirement, data on the progress of labour before pain relief suggest that epidural analgesia is a marker of pain severity and/or labour failure rather than the cause of delayed progress in low-risk pregnancies.
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Int J Obstet Anesth · Apr 1999
Anesthesia for reduction of uterine incarceration: report of two cases.
We present two cases in which anesthesia was needed for the reduction of uterine incarceration. The first case was managed with a combined spinal/epidural technique and the second with a single intrathecal injection of opioid and low dose local anesthetic. The anesthetic issues pertinent to the reduction of an incarcerated uterus are discussed and the literature briefly reviewed.
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Int J Obstet Anesth · Apr 1999
Randomized Controlled Trial Clinical TrialCentral neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.
In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). ⋯ In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.