Combined spinal-epidural analgesia in labour: its effects on delivery outcome / Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto

ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

RESUMO JUSTIFICATIVA E OBJETIVOS: A analgesia combinada raquiperidural (RP) tornou-se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto. MÉTODOS: Foram incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n = 55) ou não RP (n = 55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados. RESULTADOS: A média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7. CONCLUSÃO: Não houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.

Combined spinal-epidural analgesia in labour: its effects on delivery outcome.

BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

[Combined spinal-epidural analgesia in labour: its effects on delivery outcome]. / Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto.

BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

The effectiveness of patient-controlled epidural analgesia with ropivacaine 0.165% with fentanyl 2.0 miroc g/ml or levobupivacaine 0.125% with fentanyl 2.0 micro g/ml as a method of postoperative analgesia after major orthopaedic surgery.

This prospective randomized single-blinded study was conducted to determine whether there were differences in consumption, demand dosing and postoperative analgesia quality between PCEA using ropivacaine and levobupivacaine. Seventy patients with ASA classification I and II aged 18 to 80 years old scheduled for elective total knee replacement or total hip replacement were studied. All patients received CSE and then were randomly allocated to receive either ropivacaine 0.165% (Group A) or levobupivacaine 0.125% (Group B) both added with fentanyl 2.0 mcro g/ml via epidural route. PCEA regime was offered for 48 hours with additional standard orthopaedic practice of oral analgesia (etoricoxib 120 mg OD and paracetamol 1.0 gm QID) on the second postoperative day. Basal infusion of PCEA was at 3.0 ml/hour and discontinued after 24 hours following started of PCEA. The consumption of local anaesthetics used within the first 24 hours (basal + demand) and 48 hours (total basal + total demand) were recorded. The VAS pain score, sedation score, side effects and vital signs (blood pressure, heart rate and respiratory rate) were also recorded every four hours for 48 hours. This study showed that the total volume of drug used was significantly higher in Group A (163.31+/- 29.01 ml) than Group B (142.69 +/- 30.93ml) (p<0. 01). The mean dose of Group A for the first 48 hours after surgery was 251.43 +/- 70.02mg and was significantly greater than the mean dose of Group B (178.91 +/-42.33 mg) (p<0.01). The numbers of PCEA boluses delivered (D) and PCEA attempts (A) were higher in the Group A (22.37 +/-7.32 and 27.66 +/- 9.12) in contrast to Group B (17.63 +/- 7.71 and 24.40 +/- 11.51) but the differences were not statistically significant. The ratio D/A showed significantly higher in Group A (0.83 +/- 0.13) than Group B (0.74 +/- 0.15) (p<0. 02). The VAS pain score was similar for both groups. One patient in Group B had vomiting and there was no sedation, hypotension, pruritus or motor block recorded in both groups. In conclusion this study showed that both PCEA using ropivacaine 0.165% with fentanyl 2.0 micro g/ml and levobupivacaine 0.125% with fentanyl 2.0 micro g/ml provided effective postoperative analgesia within the first 48 hours of major lower limb orthopaedic surgery despite clinically significant dose difference. There was no hypotension, pruritus, sedation or motor block recorded in both groups.

Antrochoanal polyps: clinical presentation and the role of powered endoscopic polypectomy.

Antrochoanal polyps are a rare clinical entity. In this review of patients treated between January 1996 and September 2002, there were 18 cases of antrochoanal polyps. The mean age of patients was 20 years. Nasal obstruction was the most common symptom (17 cases, 94%), followed by rhinorrhoea (44%), epistaxis (33%), postnasal drip (28%), and snoring (22%). Chronic sinus was the most common associated rhinological finding (50%). Various surgical approaches were used: endoscopic polypectomy and middle meatal antrostomy in seven patients (38.9%), endoscopic polypectomy and inferior meatal antrostomy in three patients (16.7%) and Caldwell-Luc surgery in one patient (5.6%). No complications were noted in patients treated with powered instrumentation, including the three patients in whom combined transcanine approaches were used. We concluded that powered endoscopic polypectomy was safe and effective. It allowed a more complete dissection and may diminish the chance of recurrence.