Determination of 50% effective concentration of ropivacaine plus sufentanil in dural puncture epidural analgesia for labor / 中国医师进修杂志

Objective:To determine the 50% effective concentration (EC 50) of ropivacaine plus sufentanil for labor analgesia using the dural puncture epidural technique. Methods:Using the method of prospective study, sixty parturients requiring labor analgesia in Dalian Women and Children′s Medical Group from May 2021 to May 2022 were divided into six groups using a random number table and administered 0.3 mg/L sufentanil and ropivacaine at different concentrations: 0.05% (group D1), 0.06% (group D2), 0.07% (group D3), 0.08% (group D4), 0.09% (group D5), and 0.1% (group D6). A probit model was constructed to compute the EC 50 values and 95% confidence intervals (95% CI) of ropivacaine plus sufentanil in dural puncture epidural analgesia (DPEA) for labor. The pain intensity of uterine contractions before labor analgesia and 30 min after administration was recorded and assessed on a numeric rating scale (NRS), and decreases in blood pressures and heart rates, vomiting and nausea, postpartum headaches, and fetal bradycardia were documented. Results:When using ropivacaine plus sufentanil for labor analgesia via DPE, the EC 50 was 0.061%, and the 95% CI ranged from 0.051 to 0.067; the 90% effective concentration (EC 90) was 0.081%, and the 95% CI was between 0.074 and 0.098. Among the six groups, there was one case of fetal bradycardia in group D3 and one case of decreased heart rates in group D4. No decreased blood pressure, vomiting and nausea, or postpartum headaches were reported. Conclusions:In DPEA for labor, ropivacaine plus sufentanil has an EC 50 of 0.061%, with the 95% CI falling between 0.051 and 0.067, similar to the EC 50 value in epidural analgesia.

Maternal and newborn impact of epidural dexamethasone as an adjuvant for labor analgesia: A meta-analysis

Background@#Dexamethasone, an anti-inflammatory drug, has an assumed analgesic effect when given epidurally, with less side effects5,7. Although numerous studies have evaluated dexamethasone, there is a paucity of studies assessing its intrapartum use.@*Objectives@#To determine the effectiveness of epidural dexamethasone when used as an adjuvant for labor analgesia.@*Materials and Methods@#A meta-analysis guided by the Cochrane handbook was performed. Articles were searched through PubMed, MEDLINE, CENTRAL, Google Scholar and ClinicalTrials.gov using search strategies such as keywords and MeSH terms. Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality. Quantitative data were pooled and analyzed using Review Manager 5.4.1.@*Results@#A total of five trials involving 309 women in labor were analyzed. The pooled mean difference showed prolonged duration of epidural analgesia on patients who received epidural dexamethasone; pooled risk ratio between the experimental and control group demonstrated no significant maternal adverse events such as nausea and vomiting, shivering, hypotension, and fever. Pooled risk ratio and mean difference also showed that epidural dexamethasone had no significant effect on the neonatal APGAR and neonatal umbilical pH.@*Conclusion@#Present data demonstrated the potential role of dexamethasone as an adjuvant to epidural solution during labor analgesia on providing local anesthetic dose sparing effect through prolongation of the duration of epidural analgesia, with limited maternal and neonatal adverse events. These results should be interpreted with caution before adopting this technique in routine clinical practice.

Effects of Epidural Labor Analgesia plus Dexmedetomidine on Postpartum Depression in Parturients： A Prospective Study / 中山大学学报(医学科学版)

ObjectiveTo investigate the effects of epidural analgesia plus dexmedetomidine infusion on postpartum depression in parturients with natural childbirth. MethodsWe selected 70 parturients aged between 22 and 36， with singleton， term， cephalic presentation， natural delivery and ASA class I or Ⅱ. The cases undergoing epidural analgesia with ropivacaine and sufentanil were randomly divided into two groups by using a random number table （n=35 for each group）. The control group （Group C） used intravenous infusion of normal saline， while the experimental group （Group D） used equivalent volumes of intravenous infusion of dexmedetomidine. Participants were followed up at 1， 6， 12 weeks after childbirth to assess the severity of postpartum depression. Blood samples were collected at 12 h and 48 h after childbirth to measure the serum prolactin levels. The hemodynamic （HR and MAP） changes， VAS scores， and Ramsay scores were recorded at five time points： before analgesia （T1）， 10 min after analgesia （T2）， 30 min after analgesia （T3）， 12 h （T4） and 24 h （T5） after delivery. The number of analgesia pump presses and adverse events were also documented. ResultsCompared with Group C， Group D showed significantly lower EPDS scores at 1 week after childbirth， significantly higher prolactin concentrations at 12 h and 48 h after childbirth， significantly lower VAS scores at T2， T3 and T4， significantly higher Ramsay score at T3 and significantly reduced number of analgesia pump presses （P < 0.05）. ConclusionEpidural analgesia plus intravenous infusion of dexmedetomidine can alleviate early postpartum depression in women undergoing natural delivery， promote early prolactin secretion and provide a safe and effective adjunctive analgesic and sedative effect.

Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review

Abstract Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by raised intracranial pressure of unknown etiology with normal cerebrospinal fluid (CSF) composition and no brain lesions. It occurs in pregnant patients at approximately the same frequency as in general population, but obstetric and anesthetic management of the pregnancy and labor remains controversial. In this article we provide a multidisciplinary review of the main aspects of IIH in pregnancy including treatment options, mode of delivery and anesthetic techniques. Additionally, we report three cases of pregnant women diagnosed with IIH between 2012 and 2019 in our institution.

Current status and influencing factors of protracted postpartum urinary retention in women with labor analgesia / 中国实用护理杂志

Objective:To explore the current status and the influencing factors of protracted postpartum urinary retention(P-PUR) in women with labor analgesia, so as to provide evidences for early diagnosis and timely intervention for P-PUR.Methods:A total of 41 995 women who were given vaginal delivery under labor analgesia from January 2017 to October 2020 in Women′s Hospital of Nanjing Medical University were chosen as the research objects. A retrospective analysis was performed for the clinical data of 62 women with P-PUR, and a 1∶4 matching case control study was conducted. Logistic regression analysis was used to analyze the variables with statistical difference in univariate analysis, so as to explore the independent influencing factors of P-PUR in women with labor analgesia.Results:Among 41 995 women with labor analgesia, 62 women suffered from P-PUR, and the incidence was about 0.15% (62/41 995). The Logistic regression model showed that nulliparity ( OR=121.80, 95% CI 8.59-1 727.40, P<0.05), forceps delivery ( OR=13.41, 95% CI 2.21-81.58, P<0.05),Ⅱdegree porineal iaceration ( OR=0.04, 95% CI 0.01-0.11, P<0.05), episiotomy ( OR=0.13, 95% CI 0.04-0.47, P<0.05) and perineotomy with perineal laceration ( OR=0.20, 95% CI 0.06-0.63, P<0.05) were the independent risk factors. Conclusions:For primiparas with labor analgesia, interventions should be taken to reduce perineal injury, and indications of forceps delivery should be strictly controlled, so as to reduce P-PUR and adverse urinary tract complications.

Acupoint Injection Decreases Anesthetic Cosumption during Combined Spinal-Epidural and Patient-Controlled Epidural Labor Analgesia / 中国结合医学杂志

OBJECTIVE@#To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia (CSEA) and patient-controlled epidural analgesia (PCEA) for labor analgesia.@*METHODS@#A total of 307 participants were prospectively collected from July 2017 to December 2019. The participants were randomized into the combined acupoint injection with CSEA plus PCEA group (AICP group, n=168) and CSEA plus PCEA group (CP group, n=139) for labor analgesia using a random number table. Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process, and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli (ST 36) and Sanyinjiao (SP 6) were selected in addition. The primary outcome was Visual Analogue Scale (VAS) score, and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses. Safety evaluations were performed after intervention.@*RESULTS@#The VAS scores were significantly lower in the AICP group than in the CP group at 10, 30, 60, and 120 min after labor analgesia (all P<0.05). The latent phase of the AICP group was shorter than that of the CP group (P<0.05). There were less additional anesthetics consumption, lower incidences of uterine atony, fever, pruritus and urinary retention in the AICP group than those in the CP group (all P<0.05).@*CONCLUSION@#Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption, improve analgesic quality, and reduce adverse reactions in the parturients. (Registration No. ChiMCTR-2000003120).

The comparison of the application effect of labor analgesiabetween acupoint pressure pill massage combined with salt pack hot compress and free body position alone / 中国医师进修杂志

Objective:To explore the effect of acupoint pressure pill massage combined with salt pack hot compress and free body position alone for labor analgesia.Methods:One hundred and eighty pregnant women hospitalized in the Sixth People′s Hospital of Huizhou from January 2019 to December 2020 were selected and randomly divided into the control group and the observation group, each group with 90 patients. The control group received free body position to relieve labor pain. On the basis of the control group, the observation group used acupoint pressure pill massage combined with salt pack hot compress to relieve labor pain. The effects of the two methods on patients′ pain and the visual analogue scale (VAS) during different stages of labor and the outcome of the two groups were compared.Results:The rate of labor analgesia efficacy in the observation group was better than that in the control group : 98.89%(89/90) vs. 92.22%(86/90), the difference was statistically significant ( χ2 = 4.71, P<0.05). The scores of VAS in the observation group during the first, second and third stages of labor were lower than those in the control group ( P<0.01). The time of the first, second and third stages of labor and the total time of labor in the observation group were all lower than those in the control group ( P<0.01). At the end of the first stage of labor, the levels of β-endorphin and norepinephrine in the observation group were higher than those in the control group: (173.98 ± 32.87) ng/L vs. (139.43 ± 38.94) ng/L, (80.43 ± 10.98) nmol/L vs. (72.02 ± 11.21) nmol/L; the levels of dopamine were lower than those in the control group: (1.04 ± 0.23) mg/L vs. (1.23 ± 0.25) mg/L, the differences were statistically significant ( P<0.01). The rate of natural delivery in the observation group was higher than that in the control group: 95.56%(86/90) vs. 86.67% (78/90), χ2 = 4.39, P<0.05. Conclusions:Acupoint pressure pill massage combined with salt pack hot compresscan effectively alleviate the pain of child birth, reduce their pain, but also shorten their labor process, promote them to deliver rapidly.

Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients' satisfaction, and side effects were collated. The level of significance was set at <0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13).Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects

Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.

Influence of different rates of programmed intermttent epidural administration in labor analgesia in lying-in women / 吉林大学学报(医学版)

Objective: To explore the effect of enhancing the rate of programmed intermittent epidural bolus (PIEB) on the labor analgesia and the dosage of ropivacaine supplement in the lying-in women, and to provide the basis for studing labor analgesia. Methods: One hundred and twenty-six women with a singleton pregnancy received labor analgesia with PIEB method and were randonly divided into low-rate group (n=60) and high-rate group (n= 66). Epidural infusion was given the initial loading dose of 10 mL (0.09 % ropivacaine+0.4 mg · L-1 sufentanil), followed by 100 mL pulse injection pump (0.09 % ropivacaine + 0.4 mg · L-1 sufentanil). Every 60 min, intermittent bolus of 10 mL was given; the patient were administered with the rates of 100 mL · L-1 (low-rate group) or 200 mL · L-1 (high-rate group). The drug administration time of patient-controlled epidural analgesia (PCEA) was set as 5 mL, and the locking time was set as 30 min. The initial pain visual analog scale (VAS) score, duration of labor, delivery mode, supplementary amount and frequency of ropivacaine, first supplementary time of ropivacaine, a mount of PCEA pump, maternal satisfaction score, maximum sensory block level, as well as the incidence of adverse events, such as nausea and vomiting, hypotension, respiratory depression and fever of the lying-in women in the analgesia period were recorded. Results: The initial pain VAS scores, duration of labor, natural delivery rates, assisted vaginal delivery rates and cesarean section rates of the patients in two groups had no significant differences (P> 0.05). There were no significant differences in the amount and frequency of supplementary, the first supplement time of ropivacaine, the amount of PCEA pump between two groups (P> 0.05). The satisfaction scores of the lying-in women in two groups had no significantly difference (P<0.05). The highest analgesia level in two groups was T7-T8, and no adverse events, such as nausea and vomiting, hypotension, respiratory depression and fever, were observed in all the lying-in women. Conclusion: Compared with low-rate PIEB labor analgesia, the effect of labor analgesia, times of need for supplemental analgesia and the consumption of ropivacaine per hour are not improved by high-rate PIEB.

Effect evaluation of two labor analgesia methods with Doula services / 预防医学

Objective @#To evaluate the effects of transcutaneous electrical nerve stimulation ( TENS ) and waterbirth with Doula services on the outcome of delivery. @*Methods@#From July 2018 to December 2019, 150 primiparas in Hangzhou Women's Hospital were randomly divided into three groups: TENS, waterbirth and control groups. They were given TENS, waterbirth and conventional midwifery, accompanied by Doula services. The visual analogue scores ( VAS ) , length of labor stages and neonatal asphyxia were compared.@*Results@#It finally included 45 cases in the TENS group, 45 cases in the waterbirth group and 44 cases in the control group. There were no significant differences in gestational weeks, age, height, weight, fetal biparietal diameter and newborn birth weight among the three groups ( P>0.05 ) . The VAS scores of TENS group and waterbirth group were lower than those of the control group ( P<0.05 ) , but there were no significant differences between the two groups ( P>0.05 ) with the cervix open to 2.5-3 cm, 5-7 cm ( 0.5 hours later ) and 10 cm. There was no interaction between the analgesia methods and cervix diameter ( P>0.05 ) . The duration of the first stage of labor in the TENS group and the waterbirth group was less than that in the control group ( P<0.05 ) , and there was no significant difference between the TENS group and the waterbirth group ( P>0.05 ) . The asphyxia rate of neonates in TENS group, waterbirth group and control group were 2.22%, 2.22% and 4.55%, respectively, with no significant difference ( P>0.05 ) . @*Conclusion@#Under Doula services, both TENS and waterbirth can effectively relieve the pain of delivery and shorten the first stage of labor, without obvious differences.

Effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia / 中国针灸

OBJECTIVE@#To observe effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia and explore its possible mechanism.@*METHODS@#A total of 160 primipara were randomly divided into an observation group (80 cases, 12 cases dropped off ) and a control group (80 cases, 15 cases dropped off ). The primipara in the control group received epidural labor analgesia. In the observation group, 15 min after epidural labor analgesia was performed, magnetic beads auricular point sticking therapy was given at shenmen (TF@*RESULTS@#There was no significant difference in tympanic temperature in the observation group at each time point (@*CONCLUSION@#Magnetic beads auricular point sticking therapy can reduce the amount of anesthetics, decrease the effect of epidural analgesia on primipara's body temperature regulation and labor progress, and lower the incidence of fever during labor analgesia by regulating the level of inflammatory response in the primipara.

Effect and safety of electroacupuncture analgesia at the latent stage of labor on the epidural analgesia / 针刺研究

OBJECTIVE: To investigate the effect of electroacupuncture (EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia. METHODS: According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group (37 cases), a sham-EA group (36 cases) and an epidural block group (31 cases). In the EA group, when the cervix opened up by 1 cm, Han's acupoint nerve stimulation apparatus was attached to bilateral Hegu (LI4) and bilateral Sanyinjiao (SP6) to achieve EA analgesia till the active stage (the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale (VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation (T1), 2 h of EA stimulation (T2), at the moment of epidural block (T3) and the complete open of the cervix (T6), the venous blood sample was collected to determine the concentration of beta-endorphin (beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded. RESULTS: There was no statistical difference in immediate of EA stimulation (T0) among the groups in VAS score (P>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately (P0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group (P0.05). CONCLUSION: Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.

Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome

Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects.

Neuraxial labor analgesia: a literature review / Analgesia de parto no neuroeixo: uma revisão da literatura

Abstract The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic. The techniques were divided into the following topics: induction (epidural, combined epidural-spinal, continuous spinal, and epidural with dural puncture) and maintenance of analgesia (continuous epidural infusion, patient-controlled epidural analgesia, and intermittent epidural bolus). Epidural analgesia does not alter the incidence of cesarean sections or fetal prognosis, and maternal request is a sufficient indication for its initiation. The combined technique has the advantage of a faster onset of analgesia; however, patients are subject to a higher incidence of pruritus resulting from the intrathecal administration of opioids. Patient-controlled analgesia seems to be an excellent technique, reducing the consumption of local anesthetics, the number of anesthesiologist interventions, and increasing maternal satisfaction.

Resumo O uso de técnicas de analgesia para o trabalho de parto tem se tornado cada vez mais frequente. As técnicas neuroaxiais são as mais comumente usadas e de maior eficácia. A dor do trabalho de parto traz uma série de consequências fisiológicas que podem ser negativas para a mãe e para o feto, e por isso deve ser tratada. Esta revisão de literatura foi feita na base de dados PubMed, de julho a novembro de 2016, e foram incluídos artigos em inglês ou portuguê publicados entre 2011 e 2016, ou mais antigos que fossem relevantes ao tema. As técnicas foram divididas nos tópicos: indução (peridural, raquiperidural combinada, raquianestesia contínua e peridural com punção dural) e manutenção da analgesia (infusão peridural contínua, analgesia peridural controlada pela paciente e bolus peridural intermitente). A analgesia peridural não altera a incidência de cesarianas nem o prognóstico fetal, e o desejo materno é indicação suficiente para seu início. A técnica combinada apresenta como vantagem um início mais rápido da analgesia, entretanto as pacientes estão sujeitas a maior incidência de prurido decorrente da administração intratecal de opioides. A analgesia controlada pela paciente parece ser uma excelente técnica, diminui o consumo de anestésicos locais e o número de intervenções do anestesiologista e aumenta a satisfação materna.

Comparative Study of Levobupivacaine with Fentanyl Versus Ropivacaine with Fentanyl for Labor Analgesia

Effective pain relief is one of the important components of management of normal labor. Adequate pain relief is associated with reduction in maternal sympathetic activity and considerably decreased maternal anxiety level. Epidural analgesia is being increasingly used for this purpose. Many local anesthetic drugs are being used for providing epidural analgesia. We conducted this study to compare Ropivacaine and Levobupivacaine in terms of onset and duration of analgesia, motor involvement, hemodynamic effects and neonatal outcome. Methods: This was a prospective comparative study in which 100 patients presenting in spontaneous labour were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups on the basis of drug used. Group A patients received Ropivacaine along with fentanyl whereas group B patients received Levobupivacaine along with fentanyl. VAS score, Sensory and motor block and vital parameters were recorded before giving epidural and 5,15, 30 and 60 minutes and thereafter every hourly till delivery took place. Sensory block was assessed by pin prick sensation whereas motor block was assessed by modified bromage scale. Statistical analysis was done using SSPS 21 software and p value less than 0.05 was taken as statistically significant. Results: Parameters such as height, weight, body mass index, ASA grades, gravidity and duration of labor were found to be comparable in both the groups with no statistically significant difference in between 2 groups (P>0.05). Mode of delivery and conversion to LSCS was also similar in both the groups. Mean time for onset of analgesia was comparable in both the groups. The mean VAS scores in group A were found to be less as compared to group B during initial 1 hour after the bolus dose and the difference was found to be statistically significant (P<0.0001). After 1 hour the VAS scores were found to be comparable in both the groups with no statistically significant difference in the mean VAS scores of patients in both the groups (P>0.05). The need for top-up analgesia was found to be statistically significantly higher in group B as compared to group A (P=0.0277). The motor sparing was better in group A as compared to group B and the difference was found to be statistically significant (P=0.0026). Hemodynamics and neonatal outcome were found to be comparable in both the groups (P>0.05). Conclusion: Ropivacaine is a better local anesthetic drug as compared to Bupivacaine for labor analgesia. Its use is associated with better analgesic effect, superior motor sparing and less need for top up analgesic doses.

​Comparative Evaluation Of 0.2% Ropivacaine Versus 0.125% Ropivacaine Under Combined Spinal-Epidural Technique For Labor Analgesia

Background: Both pharmacological and non-pharmacological strategies for pain relief in labor have been tried and tested sincelong. Combined spinal-epidural analgesia (CSEA) satisfies the basic requisites of labor analgesia. Various concentrations oflocal anesthetics along with the addition of opioids can be used. The objective of this study is to compare the quality of laboranalgesia with two different concentrations of ropivacaine (0.2% vs. 0.125%) and assess fetomaternal outcome.Materials and Methods: A total of 60 primipara women with a singleton pregnancy in active labor were given CSEA afterrandomly allocating them in two groups of 30 each. Both Group A and Group B received intrathecal injection of 4 mg (2 ml)0.2% ropivacaine + 25 µg (0.5 ml) fentanyl: Group A - epidural dose of 15 ml of 0.2% ropivacaine solution + 2 µg/ml fentanyland Group B - epidural dose of 15 ml of 0.125% ropivacaine + 2 µg/ml fentanyl. Then, continuous epidural infusion was startedat the rate of 10 ml/h which was continued until the end of delivery.Results: GroupA showed better maintenance of analgesia and better maternal satisfaction while parturients in Group B neededrescue top-up analgesia due to breakthrough pain.Conclusions: It was concluded that ropivacaine in both concentrations (0.2% and 0.125%) with fentanyl is effective forinitiation of labor analgesia. However, quality of analgesia with 0.2% ropivacaine concentration is superior to 0.125%concentration.

Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block / Bloqueio combinado raquiperidural para analgesia de parto. Estudo comparativo com bloqueio peridural contínuo

Abstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.

Resumo Introdução: O bloqueio peridural lombar constitui técnica eficaz e rotineiramente empregada para alívio da dor do parto e o bloqueio combinado raquiperidural tem como benefícios o emprego de doses menores de anestésicos locais e rápido início de analgesia. O objetivo do estudo foi avaliar comparativamente a eficácia e a segurança de duas técnicas anestésicas: bloqueio combinado raquiperidural e peridural contínua em grávidas submetidas à analgesia de parto. Método: Oitenta gestantes, ASA 2 e 3, apresentação cefálica e dilatação cervical entre cinco e seis centímetros, submetidas à analgesia de parto, distribuídas em dois grupos de acordo com a técnica anestésica: técnica combinada raquiperidural (GI) e peridural contínua (GII). Avaliaram-se: intensidade de dor antes do bloqueio; tempo para completa analgesia; grau do bloqueio motor; tempo para dilatação cervical total; duração do 2° estágio do trabalho de parto; intensidade de dor durante o 1° e o 2° estágio do trabalho de parto; tipo de parto; uso de ocitocina durante trabalho de parto; parâmetros cardiocirculatórios, respiratórios e eventos adversos maternos; repercussões neonatais. Resultados: No momento da anestesia a intensidade de dor era semelhante em ambos os grupos. O alívio da dor foi mais rápido no GI (4,5 ± 1,5 min) quando comparado com o GII (11,6 ± 4,6 min) p = 0,01; os escores de dor no primeiro e segundo estágios de parto foram menores no GI (0,9 ± 0,3) e (1,8 ± 0,7) quando comparados com o GII (1,9 ± 0,6) e (2,2 ± 0,5) com p = 0,01 somente no primeiro estágio de trabalho de parto; houve necessidade de complementação com anestésicos locais no GII; partos espontâneos mais frequentes em GI (80% das pacientes) do que em GII (50%) p = 0,045 e instrumentais mais frequentes (p = 0,03) em GII (12 pacientes) quando comparadas com o GI (quatro pacientes); a frequência de partos cesáreos foi significativamente maior (p = 0,02) no Grupo II do que no Grupo I, quatro casos no GI e oito no GII; ausência de alterações cardiocirculatórias e respiratórias maternas e repercussões neonatais; prurido mais frequente no GI (10 pacientes) e (0 paciente no GII) p = 0,02. Conclusão: O bloqueio combinado mostrou-se eficaz com melhor qualidade de analgesia e maior conforto às gestantes, constitui boa opção para a prática de analgesia obstétrica.

Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial / 대한마취과학회지

BACKGROUND: Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia. METHODS: One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction. RESULTS: While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups. CONCLUSIONS: Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.

Risk prevention of neuraxial labor analgesia / 中国实用妇科与产科杂志

Labor pain threatens the health of mother and infant seriously and it accounts for the biggest part of non-medical indications of cesarean section in our country.Neuraxial labor analgesia is the most effective and commonly used therapy for pain relief during labor and delivery without increasing the rate of cesareansection.However,it can cause some side effects and complications like supine position syndrome,inadequate anesthesia and fever.To strengthen the process management of labor analgesia,clear assignment of responsibility,carring out education and training and developing complication treatment plan are important measures to prevent risks.