Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 ug.mL-l: a study in singleton breech presentation

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In the present trial, continuous epidural infusion of bupivacaine 0.125% was compared with a combination of a low concentration of bupivacaine [0.0625%] and sufentanil [0.25 ug.mL[-1]]. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between bupivacaine group [n =23] and bupivacaine-sufentanil group [n =35]. A greater number of patients in the bupivacaine 0.125% group required more than two top-ups [32% vs. 8%, P =0.03] while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a non-significant decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group [92% vs. 74%, P = 0.09]. Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was a non-significant difference in mode of delivery between the two analgesic regimens

Low-dose dexamethasone reduces nausea and vomiting after epidural morphine: a comparison of metoclopramide with saline

The efficacy of a low dose of dexamethasone [5 mg] with metoclopramide [10 mg] and saline in preventing nausea and vomiting after epidural morphine in post hysterectomy analgesia. 120 ASA physical status I and II women receiving epidural morphine for post hysterectomy analgesia. All patients received epidural morphine 3 mg for postoperative analgesia. The dexamethasone group [n = 40] received dexamethasone 5 mg, the metoclopramide group [n = 40] received metoclopramide 10 mg, and the saline group [n = 40] received saline. The occurrence of nausea and vomiting appeared more frequently during 6 to 24 hours following the administration of epidural morphine. The total frequency of nausea and vomiting in the dexamethasone group was significantly lower than that of the metoclopramide and saline groups during this period, with reporting frequencies of 21%, 49%, and 53%,respectively [p = 0.05 each]. However, the difference between metoclopramide and saline did not reach statistical significance

Hemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine

The pressor response is known to be exaggerated in patients with pregnancy-induced hypertension, which can result in increased morbidity and mortality in both mother and newborn. Various pharmacological agents have been used before induction in an attempt to attenuate the adrenergic response but with varying degree of success. Esmolol, an ultra short-acting cardioselective beta-blocker with rapid onset and short elimination half-life, is an attractive choice for attenuating the adrenergic response in pregnant patients. In a prospective, randomized double blind study the efficacy of two bolus doses of esmolol with or without lidocaine, in patients with pregnancy-induced hypertension was evaluated. Eighty such patients undergoing lower segmental caesarean section were randomly divided into four groups and received the following study drugs before intubation: group I received esmolol 1.0 mg/kg; group II received esmolol 2.0 mg/kg; group III received esmolol 1.0 mg/kg and lidocaine 1.5 mg/kg; and group IV received esmolol 2.0 mg/kg and lidocaine 1.5 mg/kg. In groups II, III and IV, the changes in maternal heart rate, systolic blood pressure and mean arterial pressure in response to laryngoscopy and intubation were attenuated to a comparable degree [P > 0.05]. No adverse effects were noticed in mother or baby. It was concluded that esmolol 1.0 mg/kg with lidocaine 1.5 mg/kg is effective in attenuating the adrenergic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension