RESUMO
BACKGROUND: Assessing block levels during regional anesthesia has been mainly performed by three sensory modalities: cold, sharp pinprick (analgesia), and pinprick touch (anesthesia). Though sharp pinprick is more commonly used, pinprick touch has been emphasized to be more accurate and predictive by some. We compared block levels and discriminating power between the three modalities in spinal anesthesia (SA) and combined spinal epidural anesthesia (CSEA). METHODS: Forty-six cesarean parturients were randomly given SA (n = 23) or CSEA (n = 23). SA was performed with intrathecal hyperbaric bupivacaine 0.5%-9 mg and fentanyl 20 microgram, and CSEA with intrathecal hyperbaric bupivacaine 0.5%-6 mg and fentanyl 20mug followed by epidural bupivacaine 0.25%-10 ml 5 min later. Upper block levels were measured with cold (alcohol swab), sharp pinprick (25G Whitacre) and pinprick touch (25G Whitacre) at 5, 10, 15, 20, 30, 60, 90, and 120 min after intrathecal injections. RESULTS: There were no complaints of pain through the operation by any patient. The maximum levels (median) using cold, sharp pinprick, or pinprick touch were T1, T2, and T4 in SA and T1, T3, and T4 in the CSEA group and there was no differences between groups. At every measuring time, there were significant differences in block heights of the three modalities in the upper mentioned order. In 5 patients (3 in SA, 2 in CSEA), there was a reverse order between the levels of cold sensation and analgesia. Pinprick touch was kept at the lowest levels at all times, and could discriminate the two blocks at two onset times (5, 10 min), sharp pinprick at one time (5 min) but cold sensation could not. CONCLUSIONS: There were marked differences in block heights measured by the three modalities in the decreasing order of cold, sharp pinprick, and pinprick touch. At the onset of the blocks, pinprick touch was the most discriminating to differentiate the two blocks, followed by a sharp pinprick.
Assuntos
Feminino , Humanos , Gravidez , Analgesia , Anestesia por Condução , Anestesia Epidural , Raquianestesia , Bupivacaína , Cesárea , Fentanila , Injeções Espinhais , SensaçãoRESUMO
BACKGROUND: This study was done to compare vacuum delivery and cesarean section rates in a large population before and after on-demand labor epidural analgesia became available. METHODS: We retrospectively investigated the overall sets of delivery modes in patients who gave birth during a 12-month period before the introduction of on-demand labor epidural analgesia, and those giving birth after labor epidural analgesia became available. Additionally, we compared the rates of cesarean section or vacuum delivery in patients delivering before and after the availability of on-demand labor epidural. RESULTS: Included were 3905 patients who delivered before, and 4318 patients who delivered after epidural analgesia became available. Labor epidural rates were 0.3% vs 14.7% for the before and after groups. The rates of cesarean delivery for dystocia in primary cesarean operation did not change (10% vs 10.5%), and vacuum delivery rates in the total vaginal delivery patients were not changed (15.1% vs 14.7%) for the before and after group. CONCLUSIONS: Increased epidural analgesia did not change the overall cesarean delivery rates for dystocia and vacuum - assisted delivery rates.
Assuntos
Feminino , Humanos , Gravidez , Analgesia Epidural , Cesárea , Distocia , Parto , Estudos Retrospectivos , VácuoRESUMO
No abstract available.
Assuntos
Escherichia coli , Escherichia , Infecções Urinárias , Sistema UrinárioRESUMO
No abstract available.
Assuntos
Feminino , Humanos , Lactente , Líquido Amniótico , Estudos ProspectivosRESUMO
No abstract available.
Assuntos
Criança , Humanos , Cateterismo Cardíaco , Cateteres Cardíacos , Cineangiografia , Cardiopatias , Coração , Estatística como AssuntoRESUMO
No abstract available.