International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2012
Letter Case ReportsAccidental epidural administration of Syntocinon.
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Int J Obstet Anesth · Apr 2012
Randomized Controlled Trial Comparative StudyA randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia.
Intrathecal morphine is an effective analgesic post-cesarean delivery; however, it may be contraindicated or unsuitable in some patients. We compared the efficacy and side effects of intrathecal morphine with an ultrasound-guided transversus abdominis plane (TAP) block in a randomized, controlled, double-blinded trial. The primary outcome was the morphine equivalents dose used in the first 24 h post-surgery. Secondary outcomes were pain scores and side effects, including pruritus, sedation, nausea and vomiting. ⋯ In this trial, the TAP block was associated with greater supplemental morphine requirements and higher pain scores than intrathecal morphine but fewer opioid-related side effects. The TAP block may be a reasonable alternative when intrathecal morphine is contraindicated or not appropriate.
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Int J Obstet Anesth · Apr 2012
Randomized Controlled TrialA sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia.
Spinal anesthesia is a standard technique for cesarean section but can cause hypotension which may be related to venous pooling secondary to progesterone-induced decreases in vascular tone. This study investigated the use of a sequential compression mechanical pump with thigh-high sleeves with compression cycles timed to venous refilling. We hypothesized that this would recruit pooled venous blood from the lower limbs, maintain the central blood volume and thus decrease the incidence of hypotension. ⋯ The use of a sequential compression mechanical pump that detects venous refilling and cycles accordingly, reduced the incidence and severity of hypotension after spinal anesthesia for cesarean section.
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Int J Obstet Anesth · Apr 2012
Randomized Controlled TrialContinuous wound infusion with ropivacaine fails to provide adequate analgesia after caesarean section.
Continuous wound infusion with local anaesthetic has been used in post-caesarean pain management with conflicting results. We carried out a study comparing three groups: continuous ropivacaine wound infusion, intrathecal morphine with saline wound infusion and saline wound infusion only. ⋯ Compared to saline control, continuous wound infusion with ropivacaine failed to reduce the use of intravenous oxycodone patient-controlled analgesia or pain scores. Intrathecal morphine decreased oxycodone consumption by 46% in the first 24 h after surgery when compared to continuous ropivacaine wound infusion.