Epidural analgesia during labor vs no analgesia: a comparative study

Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Epidural analgesia by lidocaine [0.5%] and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration

Epidural analgesia during labor-0.5% lidocaine with fentanyl vs 0.08% ropivacaine with fentanyl

Although lidocaine is a cheap and globally available local anesthetic, yet it is not a popular drug for labor analgesia. This is claimed to its higher intensity of motor block, possibility of transient neurological symptoms [TNS] and its placental transfer with probable drawbacks on fetal well-being. However, these effects could be concentration dependent and, the evidence linking them to lidocaine is still lacking. This study was designed to evaluate the efficacy and safety of 0.5% epidural lidocaine plus fentanyl during labor. One hundred and twenty healthy full term nulliparous women in early labor with a single fetus presented by the vertex were enrolled in this randomized, double-blind clinical trial. Parturient were assigned to receive epidural analgesia either with lidocaine 0.5% plus fentanyl 2 micro g [-1mL] [LF], or ropivacaine 0.08% plus fentanyl 2 micro g[-1] ml [RF] when their cervix was dilated to 4 centimeters. Analgesia was provided with 20 ml bolus of the study solution and maintained at 10 ml[-1]h. Upper level of sensory loss to cold, Visual Analogue Pain Score [VAPS], motor block [modified Bromage score], the duration of the first and second stages of labor, numbers of instrumental vaginal and cesarean deliveries, the neonatal apgar score, patient satisfaction and side effects, were recorded. There were no significant differences in sensory level, pain scores, duration of the first and second stages of labor, numbers of instrumental and cesarean deliveries, the neonatal apgar scores, patient satisfaction or side effect between groups. Although motor block was significantly high in lidocaine group compared to ropivacaine group [p<0.05], all parturient were moving satisfactorily in bed. Dilute epidural lidocaine [0.5%] with fentanyl effectively and safely initiates epidural analgesia clinically indistinguishable from 0.08% epidural ropivacaine with fentanyl. Although it induces significant motor block compared to ropivacaine, it still preserves maternal ability to move satisfactorily in bed. Whether further reduction in lidocaine concentration could trim down the motor block, remains to be investigated

Prevalence and risk factors of diabetes mellitus in an Egyptian village

A cross sectional survey, by a past history of diabetes mellitus or treatment, was done on children and adolescents group of 1768 patients [5- <20 years] screened for the asymptomatic glucosuria and confirmed by the measurement of fasting serum glucose two hours after 75 g oral glucose load. The pregnant cases [N = 172] were subjected to a glucose challenge test with a 50 glucose load. The adults >20 years [N = 2409] were screened by a random capillary glucose testing and those with 5.6 mmol/l were subjected to the measurement of fasting serum glucose and serum glucose two hours after 75 g oral glucose load. All diagnosed cases were subjected to a questionnaire interview covering the possible risk factors according to the type of diabetes. A case control study was done, where the diagnosed NIDDM [142] and impaired glucose tolerance [IGT] [55] cases as well as an age and sex matched nondiabetic control group [205] were subjected to a questionnaire interview, estimation of body mass index, determination of sedentary lifestyle and HCV antibody determination. A comparative study between the controlled [hemoglobin A1c <7%] and uncontrolled [hemoglobin A1c >7%] previously diagnosed NIDDM and IGT patients was done. These cases were subjected to KAP study for the management of the disease, clinical examination with a special reference to cardiovascular and neurological examination and an examination of the ocular fundi, any other diabetic complication and lipid profile study