Painless labor and delivery

Labor is one of the most painful situations. Unrelieved labor pain can have adverse effects both on the mother as well as the baby. In this review article we summarized the clinical application of various methods used for painless labor and delivery, especially, the new development in epidural anesthesia and analgesia [EA] technique. We discuss the best time to introduce the epidural catheter and when to start the local anesthetic drug through epidural catheter. In the light of newer studies, we compared the mode of epidural drug delivery, continuous infusion or intermittent boluses and different adjuncts to local anesthetic used in modern practice for this purpose. In various recent research studies it was found that the volume of local anesthetic drug is more important in relieving the labor pain and providing satisfaction to patient than the drug concentration. In the end, we discuss the various complications and their prevention

effect of lornoxicam with intravenous regional anesthesia on intraoperative and postoperative analgesia for forearm surgery

To evaluate the effect of lornoxicam added to lignocaine for intravenous regional anesthesia [IVRA]. Prospective, randomized, double-blind controlled study. King Fahd Hospital, University of Dammam, Saudi Arabia. Forty patients scheduled for upper limb surgery under IVRA were randomly allocated into two groups [20 patients per group] during the period from August 2010 to November 2011. All patients received 4 mg/kg body weight lignocaine in 40 ml solution plus 3 ml of study solution containing either normal saline [control group] or lornoxicam 12 mg [IVRA- L group]. Hemodynamic changes, sensory and motor block onset time, intraoperative and postoperative analgesia and total analgesic drug required in first 24 hours were observed. Onset of sensory and motor block, requirement of intraoperative fentanyl, incidence of tourniquet pain, requirement of postoperative analgesia in terms of paracetamol consumption. Patients who received the lornoxicam [IVRA-L group] had earlier onset of sensory and motor block [p < 0.001] and less requirement of intraoperative fentanyl [p < 0.001]. Lornoxicam group patients tolerated tourniquet pain better [p < 0.001] and had better postoperative analgesia for first 24 hours [p < 0.0005]. Lornoxicam 12 mg is a beneficial addition to IVRA. It shortens the sensory and motor block onset time and increases the intraoperative and postoperative analgesia without any side effects. We observed that among nonsteroidal anti inflammatory drugs [NSAIDs], lornoxicam is a very effective and safe adjunct to lignocaine for IVRA in upper limb surgery

Comparison between intrathecal morphine with paravertebral patient controlled analgesia using bupivacaine for intraoperative and post-thoracotomy pain relief

This study was designed to compare the intrathecal morphine and paravertebral block with bupivacaine given before induction of anesthesia for intra-operative and post-thoracotomy pain relief for 48 hours using patient controlled paravertebral analgesia in post-operative period. After taken an approval from the ethics committee of the University, 40 patients were randomly assigned to receive either preservative-free intrathecal morphine 0.3 mg in 3 ml normal saline together with paravertebral block [group I] or paravertebral block alone using bupivacaine [group II] before an induction of anesthesia. No continuous infusion of bupivacaine was started in both groups. Primary outcomes were Visual Analogue Score [VAS] at rest and on coughing. Hemodynamic and respiratory effects, bupivacaine consumption, patient's satisfaction, and side effects like nausea, vomiting, urinary retention, and itching were considered as secondary outcomes. All patients in both groups received paracetamol 1 gram [gm] IV every 6 hourly for the 1[st] 24 hr. Amount of rescue analgesic [pethidine 0.5 mg/kg IV] in both groups and total bupivacaine cumulative doses in 48 hrs were calculated. VAS at rest and on coughing did not differ significantly between the 2 groups at 0, 1, 6, 12, 18, 24, and 48 hours [P= > 0.1]. At 24 hours, VAS increased in both the groups, but the increase in VAS was comparable in both groups. There were insignificant incidences of nausea, purities, and urinary retention in intrathecal group compared with paravertebral group. The other side effects and patient satisfaction did not show any statistical significant difference between 2 groups. Intrathecal morphine 0.3 mg is safe and effective way to improves pain control for thoracic surgery and was comparable to paravertebral patient control analgesia [PPCA] with bupivacaine for the 1[st] 48 hours post-thoracotomy