Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2002
Meta Analysis Comparative StudyIntrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.
Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. ⋯ Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.
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Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and data to document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anesthetic and anastomotic leakage by reviewing the literature. ⋯ So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.
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Reg Anesth Pain Med · Sep 1998
Randomized Controlled Trial Meta Analysis Comparative Study Clinical TrialRegional anesthesia does not significantly change surgical time versus general anesthesia--a meta-analysis of randomized studies.
The major determinant of variable operating room costs is surgical time. A number of factors contribute to surgical time. This study was designed to determine whether regional anesthesia decreases surgical time when compared with general anesthesia over several surgical procedures. ⋯ Overall, the use of regional anesthesia does not significantly decrease surgical time.