Articles: analgesia.
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The practice of administration of labor analgesia has undergone dramatic changes this decade. This is largely attributable to unparalleled interest in the field by many dedicated and capable investigators around the world. Through their efforts, this decade has witnessed the introduction of new techniques (pencil point needles, CSE, PCEA, ultradilute epidural regimens) that have permitted us to come closer than ever to realizing the goal of complete relief from the pain and suffering of labor while safeguarding the well-being of mother and child and minimizing effects on the labor process. Neuraxial anesthetic techniques and modern multimodal analgesic approaches to postoperative pain relief now minimize the effects of cesarean delivery on maternal satisfaction and participation in the birth process.
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Arch Pediat Adol Med · Jun 2000
Comparative Study Clinical TrialCombined analgesia and local anesthesia to minimize pain during circumcision.
Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers. ⋯ Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.
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Multiport epidural catheters are popular; however, the reliability of the air test has not been evaluated with this catheter design. The authors determined the effectiveness of aspirating for blood and the air test in detecting intravascular multiorifice epidural catheters. ⋯ The authors obtained false-negative results with both catheter aspiration and the air test. Fractionating the local anesthetic dose is important when using multiorifice epidural catheters.
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The spread of epidural analgesia is facilitated by pregnancy. Changes in the epidural structure during pregnancy may affect the spread of analgesia in pregnant women. To investigate the changes in the epidural space produced by pregnancy, the authors performed epiduroscopy in pregnant women. ⋯ Epidural blood vessels become engorged in the first trimester; the density of the vascular networks increase in the third trimester. These changes in the epidural space during pregnancy may affect the spread of epidural analgesia in pregnant women.
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Rev Esp Anestesiol Reanim · Jun 2000
Review[Failure of obstetric epidural analgesia and its causes].
The frequency of failure to establish and maintain an epidural block is low in Spain for surgery but higher in obstetrics. The reasons are many, but noteworthy factors are the prior experience of the anesthesiologist, the anatomical features of the patient and the type of material used. However, we lack clinical and anatomical studies of the epidural space that would allow us to come to definitive conclusions. ⋯ The anesthesiologist should avoid inserting too much of the epidural catheter and should assure firm support, checking it periodically and taking into account the patient's position. Finally the anesthetic dose should be adjusted to the progress of labor. The risk of incomplete analgesia and the possible need to insert a second epidural catheter must be discussed with the patient during preanesthetic evaluation.