International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1997
Adequacy of information and acceptability of pain relief as assessed by a postpartum questionnaire.
An audit cycle has been completed looking at the availability of information about different types of anaesthesia in labour, their usage and the degree of maternal satisfaction. The initial audit 7 years ago led to the production of an information leaflet on pain relief in labour. ⋯ The leaflet may have helped improve satisfaction and selection of analgesia in primigravide. However, the leaflet needs updating to include some information on caesarean section now that this has become such a common form of delivery.
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Int J Obstet Anesth · Oct 1997
Patients' assessment of sensory levels during epidural analgesia in labour.
Thirty women in established labour and with epidurals in situ were asked to assess the sensory level of the epidural using loss of light touch sensation with their own finger. This dermatomal level was then compared to the sensory level assessed by an anaesthetist using loss of cold sensation with ethyl chloride spray. ⋯ The mean dermatomal difference was 0.20 and 95% of the differences lay between 3.5 and -3.1 dermatomes. This large variation in dermatomal differences between the two methods of sensory assessment means that patient light touch is not an acceptable method of assessing epidural sensory level when compared to ethyl chloride.
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A nation-wide survey of pain relief in childbirth in Hungary was carried out in 1993. Information was provided on 104 137 deliveries in 98 units. The frequencies of different methods of pain relief for vaginal delivery were as follows: systemic opiates in 7387 cases (8.3%), epidural analgesia in 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) in 4470 cases (5%). ⋯ For 71 744 vaginal deliveries (80.5%) no pain relief was provided at all. For caesarean section (n = 13240) the rate of spinal or epidural anaesthesia was 36.7%. It was concluded that despite an increasing rate of pain relief in labour elsewhere, the numbers of epidurals are still rather low in Hungary.
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialA double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section.
In a randomized double-blind study, 40 healthy women undergoing elective caesarean section with spinal anaesthesia received either 0.3 mg diamorphine or saline with bupivacaine 0.5% in 8% dextrose. The study recorded time to the first morphine demand delivered by patient-controlled analgesia (PCA), and total morphine requirement over 24 h. In addition pain, sedation, and pruritus were assessed by non-graduated visual analogue scores (VAS). ⋯ The medians (interquartile ranges) were 5 (0, 36) mg vs 45 (26, 72) mg (P 0.0045, 95% confidence interval for the difference between the medians is 12 to 46 mg). In the diamorphine group, postoperative VAS for pain was significantly lower at 2 h and 3 h both at rest (P 0.0003, 0.003) and on moving (P 0.009, 0.002), at 8 h on moving (P 0.01), and at 12 and 24 h at rest (P 0.005, 0.029). Significantly more women suffered pruritus in the diamorphine group for the first 12 h after surgery (P 0.01).