Regional anesthesia
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In 1988, the American College of Obstetricians and gynecologists (ACOG) decided that vaginal delivery after a previous cesarean delivery (trial of labor, TOL) was an acceptable alternative to elective repeat cesarean delivery. ACOG stated that there appears to be no absolute contraindication to epidural anesthesia for labor during TOL. The concern is that should there be a uterine rupture, would the epidural anesthesia mask the abdominal pain? The incidence of complete rupture with trial of labor is reported to be 0.3-0.5%. ⋯ There have been no reports of epidural anesthesia delaying the diagnosis of uterine rupture. In the review of 10,967 patients undergoing TOL, there were no maternal deaths and only nine fetal deaths secondary to complete uterine rupture. The literature strongly suggests that epidural anesthesia is safe in TOL even when oxytocin is used for augmentation of labor.
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Regional anesthesia · Jan 1990
Review Biography Historical ArticleThe Bier block after 80 years: a historical review.
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Regional anesthesia · Jan 1989
ReviewASRA lecture 1988. The changing role of the anesthesiologist in pain management.
Changing concepts of pain mechanisms deemphasize the somatic aspects of chronic pain and enhance the concept that chronic pain is primarily a psychological disorder. As such, interruption of straight-through pain pathways through nerve blocking may not always be the treatment of choice. Evidence is given encouraging anesthesiologists to modify their thinking on the value of nerve blocks in the treatment of chronic pain and direct their efforts to the management of acute, postoperative, and cancer pain problems.