International journal of obstetric anesthesia
-
Int J Obstet Anesth · Apr 1998
Continuous caudal analgesia in labour for a patient with Harrington rods.
We report the case of a 29-year-old patient who had Harrington rods inserted from T8 to L4 at the age of 14. She had been discouraged from having epidural anaesthesia in the antenatal clinic but, whilst in labour, requested analgesia in addition to Entonox and pethidine. Continuous caudal analgesia was commenced and provided good pain relief for labour and delivery.
-
Int J Obstet Anesth · Apr 1998
Epidural analgesia in labour using intermittent doses determined by midwives.
Since 1985 midwives have been responsible for choice of drug and timing of epidural top-up doses for women in labour at Flinders Medical Centre. The midwife may choose from one of three different prescribed preparations, namely: bupivacaine 12.5 mg plus pethidine 25 mg, bupivacaine 25 mg, and bupivacaine 50 mg - each made up in a volume of 10 ml. This prospective study examined the incidence of adverse effects and level of patient satisfaction with midwife-managed epidural analgesia. ⋯ Women reported a high level of satisfaction with the overall experience of childbirth, though this was lower for instrumental and caesarean deliveries than for vaginal deliveries. On the other hand, satisfaction with pain relief provided by the epidural was greater in women who had caesarean or instrumental deliveries. The most commonly cited benefits of epidurals were good pain relief (83%), ability to cope (74%), feeling relaxed (67%), and being aware (60%), while feeling numb (23%) and experiencing severe pain at delivery (17%) were the most common causes of dissatisfaction.
-
Int J Obstet Anesth · Apr 1998
Neonatal effects of patient-controlled analgesia using fentanyl in labor.
Patient-controlled analgesia (PCA) has been used at our institution for the past 5 years, as an alternative labor analgesic when epidural analgesia is contraindicated. This retrospective study evaluates the effects of maternal PCA fentanyl on infants of greater than 32 weeks gestational age. The neonatal charts (n=32) were reviewed for birth weight, gestational age, 1 min and 5 min Apgar scores, use of naloxone and umbilical venous gases. ⋯ Three infants with a 1 min Apgar of 4 required naloxone. The total fentanyl received by mothers of infants who required naloxone was significantly higher than the group of mothers whose infants did not require naloxone (770 +/- 233 microg vs 298 +/- 287 microg, P = 0.027) Use of PCA fentanyl in this high-risk obstetric population was associated with a 44% incidence of moderately depressed neonates with an Apgar score