International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialNalmefene or naloxone for preventing intrathecal opioid mediated side effects in cesarean delivery patients.
This study was designed to evaluate the efficacy of nalmefene vs. naloxone in preventing side effects resulting from intrathecal opioids, in patients undergoing cesarean delivery. Eighty patients who were scheduled for elective cesarean delivery under spinal anesthesia were included in a double-blind, placebo-controlled study. ⋯ There was a significant difference among the groups with respect to the occurrence of vomiting (P < 0.03): both nalmefene groups had a higher rate of vomiting than did the control group; the 0.25 microg.kg(-1) nalmefene group had a higher rate than did the naloxone group. The use of narcotic antagonists does not result in improved comfort in obstetrical patients receiving intrathecal morphine and fentanyl.
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Int J Obstet Anesth · Jul 1997
Randomized Controlled Trial Clinical TrialFeto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section.
Ropivacaine is a new amino amide local anesthetic less lipophilic and with a lower affinity for plasma proteins than bupivacaine. The purpose of this study was to examine the feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section. Healthy parturients were randomly allocated in a double-blinded manner to receive either 0.5% ropivacaine or 0.5% bupivacaine through a lumbar epidural catheter. ⋯ At delivery, the maternal free plasma concentration of ropivacaine was more than twice that of the free concentration of bupivacaine (0.072 vs 0.032 microg/ml, P = 0.002). The free concentration of ropivacaine was about twice that of bupivacaine in the umbilical venous (0.06 vs 0.03 microg/ml, P = 0.001) and umbilical arterial (0.05 vs 0.02 microg/ml, P = 0.007) plasma. The more rapid plasma clearance of bupivacaine compared to ropivacaine, leading to lower maternal plasma concentrations and hence to lower umbilical concentrations at delivery, could be explained by the higher lipid solubility, hence greater distribution volume, of bupivacaine.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialPatient-controlled analgesia following caesarean section: a comparison of morphine and meptazinol.
Forty-eight women were investigated in a prospective double-blind study and randomised to receive intravenous patient-controlled analgesia (PCA) with meptazinol or morphine following elective caesarean section. Women received PCA boluses of 1 mg morphine or 10 mg meptazinol with no background infusion. ⋯ There was no statistically significant difference in pain scores (P = 0.47) or the incidence of side-effects (nausea/vomiting P = 0.076, sedation P = 0.63) between the two drugs. Meptazinol is more expensive and offers no clinical advantages in this group of patients.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialA comparison of catheter vs needle injection of local anesthetic for induction of epidural anesthesia for cesarean section.
It is generally believed that bolus injections of local anesthetic through an epidural needle produce a more rapid onset of blockade, but at the expense of an increased incidence and severity of hypotension, whereas intermittent injections through a catheter take longer to achieve adequate anesthesia but with a lower risk of hypotension. The present study investigated two commonly used needle and catheter epidural injection techniques for differences in speed of onset of surgical anesthesia and incidence and severity of hypotension. ⋯ No significant difference was found for the time to onset of surgical anesthesia. In the absence of benefits of needle injection, incremental catheter administration of local anesthetic with its multiple safety advantages is the technique of choice for induction of epidural anesthesia for cesarean section.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialAnalgesia after caesarean section: patient-controlled intravenous morphine vs epidural morphine.
In a randomized, double-blind study, conducted in 60 patients after caesarean section, we compared epidural morphine (5 mg) with intravenous morphine patient-controlled analgesia (PCA). Efficacy of pain relief (visual analogue scale), comfort, satisfaction and side-effects were studied. In the PCA group, pain scores were higher (P < 0.005) from the third hour onward. ⋯ Consumption of morphine was higher in the PCA group. We conclude that epidural morphine analgesia, though of good quality, was associated with more pruritus. Morphine PCA, although producing a lesser degree of analgesia compared to epidural morphine, gave good satisfaction.