AANA journal
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Providing safe and effective analgesia to laboring parturients presents a challenge to anesthesia providers in small hospitals. The necessary time commitment and additional staff needed to provide coverage for the obstetrical area can strain resources. Offering the spinal opioid block as the first choice for labor analgesia and the combined spinal epidural block in selected cases permits a labor anesthesia service to address the needs of the community hospital. ⋯ The combined spinal epidural block offers the advantages of spinal opioid analgesia but with the flexibility of having an epidural catheter in place. The epidural catheter can be dosed intermittently for parturients in whom labor is prolonged, who require surgical manipulation for vaginal delivery, or who require cesarean section for delivery. By offering both blocks to laboring parturients, the appropriate block can be applied in each situation.
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Michael L. Millenson's well-documented book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, is a wake up call to both medicine and nursing for somewhat different reasons. Millenson decries the lack of scientific-based medical practice and medicine's failure to wake up due to its own historical studies. ⋯ Consumers of MEDLINE should be aware of this problem and be prepared to question the validity of research prior to adopting their conclusions. In the development of "best practices," flawed research may be as bad as personal biases and flawed memories. The potential adverse implications of flawed research for scientifically (evidenced) based practice and for health policy decisions by government and health payers with regard to the delivery of health services and its reimbursement requires that all involved do a better job of assuring that only valid, methodologically sound, and unbiased research is published, is included in the MEDLINE database, and is used in the care afforded to people in need.