International journal of obstetric anesthesia
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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).
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Int J Obstet Anesth · Oct 1997
Randomized Controlled Trial Clinical TrialIntrathecal labor analgesia: can we use the same mixture as is used epidurally?
In a randomized double-blind study, three groups of 25 term parturients received one of the following intrathecal drugs or combinations for relief of labor pain: sufentanil 7.5 microg (1.5 ml), sufentanil 5 microg + bupivacaine 1 mg (1.5 ml) or the combination bupivacaine 1.75 mg, sufentanil 1.05 microg and epinephrine 1.75 microg, that is 1.5 ml of our standard epidural mixture. After the intrathecal injection, patients received a peridural catheter for supplementation of analgesia. Onset and duration of the three regimens were similar. ⋯ More cardiotocographic changes were observed in the plain sufentanil group but this was not related to neonatal outcome. It was concluded that intrathecal injection of the standard epidural mixture offers effective and long-lasting analgesia. This may avoid side-effects and complications, manipulations of drugs with the risk for contamination, spilling of drugs and loss of time.
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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.