Effects on the labor four elements of continuous epidural analgesia in labor / 中国实用护理杂志

Objective To explore the influence of continuous epidural analgesia in labor (hereinafter referred to as labor analgesia) to the labor four elements. Methods The study included 210 parturients with analgesia during labor, form cervix opens 2 cm, based on the parturients′choose. Observe the differences in the labor analgesia parturients, through the force of labor and birth canal, fetal and psychology. Results The uterine-work after analgesia showed a trend of rising first, then dropping, reduce abdominal pressure (t=46.78, P<0.01), and the contractive ability of musculus levator ani (t=20.99, P<0.01); Soften uterus cervix (t=3.59, P<0.01) and reduced the pelvic floor muscle convergent force (t=66.90, P<0.01); Decreased the fetal heart rate range (t=6.00, P<0.01), increased fetal heat deceleration times (t=6.85, P<0.01). The differences in the position of fetus was not statistically significant (χ2=6.00, P<0.01);Lower the pain score in the labor stage (t=60.25, P<0.01), increased the self-control score during the labor (t=24.30, P<0.01) and the satisfaction score during the labor, after analgesia (t=36.61, P<0.01). Conclusions The labor analgesia influenced labor elements, include the force of labor and birth canal, fetal and psychology, or promote or restrict or maintain.

Successful Treatment of Epidural Abscess with Percutaneous Drainage: A case report / 대한마취과학회지

Continuous epidural analgesia is commonly used for chronic pain treatment as well as postoperative pain control. Epidural abscess is rare, but it is a serious complication of the continuous epidural analgesia, which leads to neurologic sequelae. Epidural catheter was inserted to a 87-year-old woman who complained of postherpetic neuralgia from T6 dermatome for continuous epidural analgesia. Two weeks later, neuralgia was aggravated along with back pain and tenderness around catheter insertion area. ESR and CRP level was also elevated. Epidural abscess was detected on MRI scan right after removal of catheter. It has been improved with percutaneous drainage via Tuohy needle with antibiotics without need for surgery. We conclude that percutaneous drainage with antibiotics is an effective method for the treatment of early diagnosed epidural abscess without neurologic deficit, especially in the high risk patients for operation.

The Breakage of Epidural Catheter during Continuous Epidural Analgesia for Cancer Pain: A case report / 대한마취과학회지

During pain control by continuous epidural analgesia, the breakage of epidural catheter is a very rare complication. We experienced breakage of epidural catheter in patient of cancer pain during continuous epidural analgesia. We performed epidural catheterization between T12 and L1 level for pain control. After 6 weeks of epidural catheterization, abruptly patient complained severe pain. When we applied negative pressure to catheter by syringe before epidural injection of bolus dose, a few airs were aspirated. We strongly suspected breakage of catheter, and the breakage in 1617 cm from epidural catheter tip was confirmed by normal saline administration via epidural catheter. After new epidural catheter inserted again, patient's pain was controlled by VAS 24 and another complications were not appeared. We must carefully manage the catheter because of complications of epidural catheter.

A Comparison of Patient-Controlled Epidural Analgesia and Continuous Epidural Analgesia after Total Knee Arthroplasty in Elderly Patients over 60 Years of Age / 대한마취과학회지

BACKGROUND: In postoperative analgesia of total knee arthroplasty (TKA) in elderly patients, epidural analgesia has been proved to be a highly effective method. The goal of this study was to compare between patient-controlled epidural analgesia (PCEA) and continuous epidural analgesia (CEA) for their efficacy of analgesia, analgesic requirement and side effects after TKA in elderly patients. METHODS: Eighty eight elderly patients over 60 years, undergoing TKA were randomly allocated to PCEA and CEA group. The PCEA group could demand a 2 ml bolus of 0.1% levobupivacaine and 0.0002% fentanyl solution with a lockout interval of 8 minutes, a total dose limit of 15 ml/h and a basal infusion rate of 3 ml/h. The CEA group received a continuous basal infusion of 5 ml/h of the same solution. The pain scores (verbal numerical rating scale, VNRS) at rest and coughing, analgesic consumption, patient satisfaction and side effects were recorded immediately before and at 1, 3, 6, 12, 24, 48 hour after the initiation of epidural analgesia. RESULTS: VNRS revealed no intergroup differences at each time interval, and were not exceeding 3 in both groups. The PCEA group (n = 44) revealed significantly less analgesic consumption compared to the CEA group (n = 44, P < 0.05), but no significant intergroup differences were noticed in side effects. CONCLUSIONS: PCEA using 0.1% levobupivacaine and 0.0002% fentanyl solution for postoperative analgesia after TKA in elderly patients provide comparable analgesia and side effects with less requirement of analgesics in comparison to CEA.

Bupivacaine plus fentanyl for intrapartum continuous epidural analgesia.

Labour pain relief using 0.125% bupivacaine plus fentanyl for intrapartum continuous epidural analgesia and intravenous pethidine plus phenergan were evaluated by randomized clinical trial in 40 patients seen at the labour room of Siriraj Hospital. The progression of labour, pain levels at 15 minutes before and after drug administration and in the second stage, the method of delivery and all side effects within two groups were observed and compared. From the study, it was found that continuous epidural analgesia with the new drug combination was more effective in relieving labour. There was no significant difference in the progression of labour and the frequency of instrumental delivery. The main side effects of nausea, vomiting and somnolence were observed to be less in the study group less than other patient but one parturient was found to have developed hypotension.