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Abstract Background and objectives: It has been observed a general public increased search on the Internet for health information, including Anesthesiology. The objective of this study was to evaluate the information available to the lay person in Portuguese on the Internet about labor analgesia for the Brazilian population. Method: Using the term "labor anesthesia", the first 20 sites found on Google in November 2014 were evaluated by two resident physicians and classified as medical and non-medical. Legibility and Design - accessibility, reliability and navigability-were compared using Flesch Reading Ease Score (FRESH) and Minervation validation tool for healthcare websites (LIDA) tools. The websites' content was confronted with that of the medical literature. Results: Medical and non-medical websites were considered difficult to read according to FRESH. Regarding the design, there was no difference between groups regarding navigability, however, accessibility was considered superior in non-medical websites (p = 0.042); while reliability was higher in medical websites (p = 0.019). Conclusions: With the increased search for health information on the Internet and concern about improving the quality of childbirth care, it is fundamental that the content available to the layperson about labor analgesia is of quality and well understood. This study demonstrated that both medical and non-medical websites are difficult to read and that non-medical websites are more accessible while the medical ones are more accurate.
Resumo Justificativa e objetivos: Observa-se um crescimento da busca de informação no público geral sobre temas médicos na internet, inclusive em anestesiologia. O objetivo deste estudo foi avaliar a informação existente ao leigo na internet em língua portuguesa sobre analgesia de parto para a população brasileira. Método: Com o uso do termo "anestesia de parto", os 20 primeiros sites encontrados no Google em novembro de 2014 foram avaliados por dois médicos residentes e classificados como médicos e não médicos. Legibilidade e desenho - acessibilidade, confiabilidade e navegabilidade - foram comparados por meio das ferramentas Fresh (Flesch Reading Ease Score) e Lida (Minervation Validation Tool for Healthcare Websites). O conteúdo dos sites foi confrontado em relação à literatura médica. Resultados: Sites médicos e não médicos foram considerados de difícil leitura de acordo com o Fresh. Em relação ao desenho, não houve diferença entre os grupos quanto à navegabilidade. Entretanto, a acessibilidade foi considerada superior em sites não médicos (p= 0,042); enquanto que a confiabilidade foi maior em sites médicos (p= 0,019). Conclusões: Com aumento da busca de informações em saúde na internet e aumento da preocupação de melhorar a qualidade de assistência ao parto, é fundamental que o conteúdo disponível ao leigo sobre analgesia de parto seja de qualidade e compreendido. Este estudo demonstrou que tanto sites médicos como não médicos são de difícil leitura; e que os sites não médicos são mais acessíveis, enquanto os médicos são mais precisos.
Subject(s)
Humans , Analgesia, Obstetrical , Consumer Health Information/methods , Internet Access/trends , Web BrowserABSTRACT
Objective To compare two methods of patient controlled epidural analgesia (PCEA) with 0 2% ropivacaine plus fentanyl 2?g?ml -1 with or without background infusion for labor Methods Ninety ASA Ⅰ Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each: group A received PCEA without background infusion; group B received PCEA with background infusion and group C received no analgesia of any kind and served as control PCEA included a bolus of 4 ml with a 15 minute lock out When the primigravida was in first stage of labor, an intravenous line was established and 5% glucose normal saline 500 1000 ml was being infused When the external cervical os was dilated to 3 cm, epidural catheter was placed at L 2 3 and a test dose of 4 ml was given 5 min later when no signs of subarachnoid injection was evident, block height was tested by pinprick and another 6 ml was given 30 min later in group B background infusion of 0 2% ropivacaine + fentanyl 2?g?ml -1 was started at a rate of 4 ml?h -1 until the second stage of labor began Maternal vital signs (BP, ECG, SpO 2, P ET CO 2), VAS scores, degree of motor block, drug consumption, side effects of PCEA, gas analysis of umbilical venous blood, progress of labor, and Apgar scores were noted Venous blood samples were taken before PCEA and at the end of first stage of labor for determination of serum epinephrine and norepinephrine levels Results There were no significant differences in Apgar scores, blood gas of umbilical venous blood and the durations of first and second stage of labor among the three groups There were no differences in VAS scores, degree of sensory and motor block, serum concentrations of epinephrine and norepinephrine and percentage of cesarean section between group A and B The percentage of cesarean section was significantly higher in control group than that in group A and B Plasma NE and E concentrations at the end of the first stage of labor were significantly higher in control group than those in group A and B The ropivacaine and fentanyl consumption was less and the incidence of itching and percentage of instrumental delivery were lower in group A than those in group B Conclusions PCEA with 0 2% ropivacaine and fentanyl 2?g?ml -1 was safe and effective It reduces the percentage of cesarean section PCEA without background infusion provides the same level of analgesia as PCEA with background infusion with less drugs and side effects
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Objective There is still a concern that epidural labor analgesia could affect uterinecontraction.The purpose of this study was to investigate the effect of epidural labor analgesia on uterinecontraction.Methods Forty ASA Ⅰ-Ⅱ primiparous women aged 20-30 yr at full term in normal uncomplicateddelivery were enrolled in this study.They were taller than 1.5 m and weighed less than 100 kg.The amnioticmembrane was artificially ruptured at 3 cm cervical dilation and a catheter was inserted into uterine cavity beyondthe head of the fetus and connected to a maternal-fetal monitor.The patients were randomly divided into 2 groupswith 20 patients in each group:Ⅰ control group received no analgesia and Ⅱ epidural group received continuousepidural analgesia(PCEA).An epidural catheter was placed at L_2-3.After a loading dose of 8-10 ml of the PCEAsolution(0.1% ropivacaine+1 ?g?ml~(-1) fentanyl)PCEA was started(bolus 3 ml,lockout interval 15 min andback ground infusion 6-8 ml?h~(-1)).The height of block was controlled below T_10.Blood samples were taken frommaternal vein at 3 cm cervical dilation(T_1),1h later(T_2)and at delivery(T_3)and from umbilical vein andamniotic fluid was aiso collected for determination of cortisol,PGE_2 and pitocin levels.VAS scores,intrauterinepressure,the frequency and duration of uterine contraction,the use of pitocin(%),incidence of cesareansection,the length of labor and neonatal Apgar scores were recorded.Results The maternal blood eortisolconcentration was significantly lower during PCEA(T_2,T_3)in group Ⅱ than in control group(P
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Objective To evaluate effects of ropivacaine combined with different concentrations of fentanyl for epidural labor analgesia. Methods In this multicenter double-blinded randomized study 128 parturients at full term and 2-3 cm of cervical dilatation who requested epidural analgesia were randomly allocated to one of 4 groups: group F0 received epidural ropivacaine alone (n = 33); group F1 received epidural ropivacaine with fentanyl 1 ?g?ml-1 (n = 30) ; group F2 epidural ropivacaine + fentanyl 2?g?ml-1(n = 33) and group F3 epidural ropivacaine + fentanyl 3 ?g?ml-1(n = 32). Epidural catheter was placed at L2,3 and advanced 4 cm into the epidural space in cephalad direction. A bolus of 15 ml of ropivacaine alone or with fentanyl was given after correct epidural placement was confirmed. EC50 of epidural ropivacaine was determined by up-and-down sequential experiment. The initial concentration of epidural ropivacaine was 0. 12% . If effective the next parturient received ropivacaine of lower concentration; if ineffective the ropivacaine concentration was increased. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . The analgesia was assessed using VAS score (0-10 0 = no pain, 10 = worst pain) . If VAS score was less than 3 within 30 min of ropivacaine administration, analgesia was defined as effective. EC50 of ropivacaine was calculated according to Dixon and Massey. Results Four of the 128 parturients enrolled were excluded because of uncertain results of interrupted observation. The EC50 of epidural ropivacaine for labor analgesia and the 95% confidence interval (95% CI) of EC50 were 0.110% (95% CI 0.109 0%-0.111 6%) in group F0; 0.089% (95% CI 0.087 7%-0.091 1%) in group F1; 0.073% (95% CI 0. 071 7%-0.0744%) in group F2 and 0.060% (95% CI 0.056 0%-0.634%) in group F3 respectively. The EC50 was significantly higher in group F0 than in group F1, F2 and F3 (P0.05) . The incidence of side-effect was significantly higher in group F3 than in group F0(P
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Objective To investigate the effect and safety of combined spinal-epidural analgesia (CSEA) with different doses of ropivacaine during labor. Methods One hundred ASA Ⅰ -Ⅱ full term primigravidae were randomly divided into 5 groups: group Rl (n =20), R2 (n =21), R3 (n = 21), group Y ( n = 19) and group C ( n = 20) . When the external cervical os was dilated to 3-4cm lumbar puncture was performed at L2-3 or L3-4 with a special CSE needle. 0.75% ropivacaine 0.33ml (2.5mg), 0.5ml (3.75mg) or 0.67ml (5mg) was added to 5% glucose with a total volume of 2.5ml and injected into subarachnoid space in group R1, R2 and R3 respectively. When subarachnoid block was wearing off, patient controlled-epidural analgesia (PCEA) with 0.175% ropivacaine was started (background infusion 6ml/h, bolus 2ml, lock-out time 15min) . In group Y patients received only PCEA with 0.175% ropivacaine and in group C patients received neither CSEA nor PCEA and served as control. Level of pain (VAS scores), degree of motor block (modified Bromage scores), Apgar scores and neurological and adaptive capacity scores (NACS), the progress of labor, the amount of ropivacaine used and side effects were recorded and compared. Blood samples were taken from umbilical vein for blood gas analysis immediately after delivery. Results Demographic data were comparable between groups and there were no significant differences in the progress of labor, Apgar score, NACS and blood gases of umbilical venous blood between groups. The onset of analgesia was significantly faster in group R1, R2 and R3 than that ingroup Y(P
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Objective:To compare the myocardial toxicity and the influence of MLAC—ropivacaine and MLAC—bupivacaine on myocardial zymogram of parturients during the first stage of labor while using epidural block for pain relief,and to provide experimental bases for choosing reasonable local anesthetics for labor analgesia.Methods:20 parturients were chosen and divided into two groups randomly (one is bupivacaine group,the other ropivacaine group).Each parturient received 20ml of MlAC-anesthetics at the required time.Blood samples were obtained from 20 parturients at different intervals and blood serum from these samples were preserved at -70℃ to determine their AST,LDH,CK-MB,and also to evaluate the analgesic effect,monitor and manage these parturients and fetus after analgesia.Results:There were no significant difference in the following aspects:(1)general data (2) obstetric character (3) analgesic effect,vital signs (4) Apgar scores of neonates (5) partal pattern (6) bleeding volume (7) myocardial zymogram between groups at each time point.There were significant difference in myocardial zymogram at different time.Conclusion:The change in myocardial zymogram is correlated to birth process,but it has nothing to do with analgesic formula.Both MLAC-ropivacaine and MLAC-bupivacaine are safe and effecive for pain relief during the first stage of labor by epidural block.