Two groups of mothers who underwent elective cesarean section under epidural analgesia, were studied with the aim of comparing the analgesic potency and side effects of two solutions: morphine-bupivacaine and morphine-saline. Each group comprised 100 patients. The intraoperative anesthesia was established with bupivacaine plain, 5 mg/ml, in amount 85-125 mg. Immediately after the infant was delivered, the mothers received a single epidural dose of 3 mg of preservative-free morphine chloride mixed with either 5 ml of 0.25% bupivacaine (Group I) or 0.9% saline (Group II). The intraoperative observations showed "good effect" without need for supplementation of analgesia in 82 mothers in Group I, compared with 61 mothers in Group II (p less than 0.001). The postoperative observations showed that 82 mothers in Group I were satisfied with a single dose of morphine for more than 24 hours, while in Group II the corresponding number was 63 (p less than 0.01). A significant difference in the incidence of nausea and vomiting was found between the groups; 7 of the mothers experienced nausea and 4 vomited in Group I and 17 experienced nausea and 13 vomited in Group II (p less than 0.05, for both variables). Respiratory depression was seen in one mother during surgery immediately after supplementation of morphine-bupivacaine analgesia with ketamine. Other side effects, such as itching, bradycardia and Horner's triad were rare. It may be concluded that a single epidural dose of morphine in bupivacaine will augment intraoperative analgesia and prolong postoperative analgesia. Less favorable results were obtained when morphine in saline was used. Synergism between bupivacaine and morphine is suggested.
Two groups, each consisting of 20 parturients, were given a continuous infusion of 0.25 per cent bupivacaine into the epidural space for pain relief, after test and loading doses. The analgesic effect was registered during labor. After delivery the course of the catheters in the epidural space was investigated radiologically. In the first group
Abstract. Obstetric analgesia was accomplished by segmental continuous blockade in 225 women. the technique involved automatic pump infusion of 0.25 per cent bupivacaine solution into the epidural space at a rate of 5 ml per hour after initial doses of 2 and 5 ml bupivacaine. If the analgesia was insufficient one or two single injections of 5 ml of bupivacaine were added. Statistical evaluation of the results could be carried out for 218 women, 158 of whom were nulliparae and 60 multiparae. Fully satisfactory analgesia was achieved in 96 per cent of the nulliparae and 88 per cent of the multiparae in the first stage of labor. in the second stage of labor 46 per cent of the mothers were given pudendal blockade to maintain satisfactory analgesia.
The positioning of the patient in the first stage of labor from supine to semirecumbent was of importance to spread the analgesic agent caudally, to the sacral nerve roots, and to control the pain due to stretching of the vagina and perineum. in the total material 17 per cent of the neonates were delivered by vacuum extraction. When the infusion into the epidural space was started in early labor, the incidence of vacuum extraction was 9 per cent, as compared with 38 per cent when it was started at 6 cm cervical dilatation or later (p:<0.01). 9.8 per cent of the neonates were delivered by cesarean section. Fetal head malposition occurred in 8.7 per cent. a drop in blood pressure was noted in 7 per cent of the women. the condition of the newborn was unaffected by the analgesia. the mini‐infusion system minimized the risk for infection. the danger in case of accidental intravascular injection was reduced, due to slowly administered bupivacaine. At the maternity department this technique has created a positive attitude towards epidural blockade, as mid‐wives and doctors have found it safe and easy.
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