International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialAnalgesia produced by epidural diamorphine is better following caesarean section under spinal anaesthesia than under epidural anaesthesia.
In a randomized double-blind study, the efficacy, duration of action and side-effects of epidural diamorphine 2.5 mg in 10 ml normal saline were compared following elective caesarean section under either spinal anaesthesia (using a combined spinal epidural technique, n = 32) or conventional epidural anaesthesia (n = 26). Median visual analogue pain scores were consistently lower in patients who had received spinal anaesthesia and this reached significance at 24 h (P = 0.02). ⋯ The incidence of side-effects was similar in the two groups. The improved analgesia following spinal anaesthesia is another advantage of the combined spinal epidural technique over conventional epidural anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Apr 1998
Randomized Controlled Trial Clinical TrialMaternal, fetal and placental distribution of lidocaine-epinephrine and bupivacaine after epidural administration for cesarean section.
Bupivacaine and lidocaine are both lipophilic drugs, bupivacaine being more lipophilic and protein-bound. Our earlier studies, using human placenta perfused in vitro, showed that increased placental binding of bupivacaine restricts fetal transfer compared to the higher fetal transfer of lidocaine. However, placental tissue concentrations of local anesthetics have not been determined in the clinical context. ⋯ Values for area under the concentration-time curves per unit of dose were similar. In conclusion, maternal plasma concentrations, fetal/maternal concentration ratios and placental tissue binding of lidocaine resembled those of bupivacaine after epidural administration. These findings are probably explainable by the effect of maternal hypotension on the distribution of lidocaine.
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Int J Obstet Anesth · Jan 1998
Randomized Controlled Trial Clinical TrialProphylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery.
Hypotension commonly accompanies induction of spinal anesthesia for cesarean section. To determine whether intravenous ephedrine prophylaxis would benefit prehydrated obstetrical patients presenting for elective cesarean section, we studied 30 patients randomly assigned to one of three experimental groups. All patients were preloaded with crystalloid (15 ml/kg), given spinal anesthesia and positioned with left uterine displacement (LUD). ⋯ Hypotension occurred in 6/10 control patients, 5/10 bolus patients and 5/10 infusion patients. The amount of supplemental ephedrine required to treat hypotension did not differ among groups. Although the efficacy of ephedrine prophylaxis for hypotension associated with spinal anesthesia for elective cesarean section cannot be established by the small number of patients studied, this practice does not appear to be clinically relevant at the doses studied.
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Int J Obstet Anesth · Jan 1998
Randomized Controlled Trial Clinical TrialEpidural lidocaine for cesarean delivery of the distressed fetus.
Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action. We therefore wished to compare its use with that of chloroprocaine for urgent cesarean delivery. Thirty parturients for cesarean section under epidural anesthesia were divided into three groups. ⋯ Lidocaine was detectable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective group but none from the emergency group. In parturients with preexisting epidural catheters and a baseline epidural infusion to maintain a T10 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provided excellent anesthesia.
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Int J Obstet Anesth · Jan 1998
Randomized Controlled Trial Clinical TrialAnaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.
To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner. Fifteen minutes later loss of pinprick sensation was determined. Additional local anaesthetic was titrated to achieve T6 sensory blockade. ⋯ The incidence of side-effects was unaffected by treatment group. Apgar scores were similar in the two groups. We conclude that following administration of 10-15 ml 0.5% bupivacaine plus fentanyl 50 microg, T6 sensory blockade is associated with good intraoperative analgesia without obvious maternal or neonatal respiratory depression.