International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2019
Randomized Controlled Trial Comparative StudyA triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section.
What did they do?
Tamura and team randomised 176 elective CS patients to spinal anaesthesia with or without morphine, in addition to placebo or ultrasound-guided quadratus lumborum block (QLB).
And they found
Only intrathecal morphine significantly improved analgesia, not QLB whether performed with or without spinal morphine. Thus QLB probably does not improve analgesia further beyond current best practices.
Not so fast...
While this modest-sized RCT concluded that QLB did not improve pain after caesarean section, the conclusion is i) somewhat inconsistent with earlier studies that did show benefit, and ii) the adjuvant analgesic regime1 used may not be applicable to practice outside Japan.
-
The researchers administered the remaining 90 mcg fentanyl IV, along with droperidol 1.25 mg and acetaminophen/paracetamol 15mg/kg after baby delivery. An NSAID (diclofenac 50mg) was only provided when breakthrough pain was requested. ↩
-
-
Int J Obstet Anesth · Feb 2024
Review Meta AnalysisOutcomes and outcome measures utilised in randomised controlled trials of postoperative caesarean delivery pain: a scoping review.
Inadequately treated postoperative pain following caesarean delivery can delay recovery and the ability to care for a newborn. Effectiveness studies of interventions to treat postoperative caesarean delivery pain measure different outcomes, limiting data pooling for meta-analysis. We performed a comprehensive review of existing outcomes with the aim of recommending core outcomes for future research. ⋯ Outcomes reported in RCTs for postoperative caesarean delivery pain vary widely. The results of this review suggest that standardisation is needed to promote research efficiency and aid future meta-analyses to identify optimal postoperative caesarean delivery pain management.
-
Int J Obstet Anesth · Nov 2023
Review Meta AnalysisFactors associated with epidural-related maternal fever in low-risk term women: a systematic review.
The underlying mechanism of epidural-related maternal fever (ERMF) is not fully understood. This systematic review aimed to identify factors associated with ERMF in low-risk, full-term women using neuraxial analgesia. ⋯ Many factors are associated with ERMF but may not be independent or causal. Further study is needed to clarify the interactions of these factors in ERMF development and whether modification of these factors might influence risk of ERMF.
-
Int J Obstet Anesth · Nov 2023
Controlled Clinical TrialCalculation of effective dose of phenylephrine bolus for treatment of post-spinal hypotension in pre-eclamptic patients undergoing caesarean section - a non-randomised controlled trial.
Patients with pre-eclampsia require smaller vasopressor doses compared with those with normotension for management of post-spinal hypotension during caesarean section. However, the literature has little evidence as to the phenylephrine dose required for patients with pre-eclampsia. ⋯ Patients with pre-eclampsia may need a 33% to 40% reduction in the first phenylephrine bolus dose, compared with patients with normotension, for the treatment of the first episode of post-spinal hypotension.
-
Int J Obstet Anesth · Nov 2023
Improving blood product management in placenta accreta patients with severe bleeding: institutional experience.
Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. ⋯ Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.