Purpose: To determine the effect of epidural analgesia on biochemical markers of stress, plasma oxytocin concentrations and frequency of uterine contractions during the first stage of labour. Methods: Nine nulliparous women, in spontaneous labour, with a singleton fetus and cervical dilatation < 5 cm were enrolled. Epidural bupivacaine 0.25% (range I 0 -14 ml) was administered and bilateral sensory blockade to ice 0-8 -L4) achieved. Blood samples were collected before the epidermal block and every I0 min for one hour after the block was achieved for the measurement of plasma beta-endorphin, cortical, glucose, lactate and oxytocin concentrations. No exogenous oxytocin was given. Intensity of pain was assessed at the time of the blood sampling using a I0 cm visual analogue scale (VAS). The frequency of uterine contractions was recorded for 60 rain before and after the epidural block.Results: There was a decrease in plasma beta-endorphin and cortisol concentrations after epidural block (P < 0.01).There were no changes in plasma glucose and lactate concentrations. The mean VAS for pain decreased I0 rain after epidural block was achieved and remained < 2 throughout the study period (P < 0.001 ). Mean plasma oxytocin concentrations did not change. The frequency of uterine contractions before and after the epidural block was similar. Condusions: The metabolic stress response to the pain of labour was attenuated by epidural analgesia. In contrast, plasma oxytocin concentration and frequency of uterine contractions were unaffected by the attenuation of metabolic stress response.Object~ : D&erminer reffet de l'analg&ie p&idurale sur les marqueurs biochimiques de stress, les concentrations plasmatiques d'oxytocine et la frdquence des contractions ut&ines pendant le premier stade du travail. M&hode : Neuf femmes nullipares, en travail spontan6, porteuse d'un seul foetus et pr&entant une dilatation du col de l'ut&us < 5 cm, ont dtd recrut&s. On a administrd de la bupivaca'ine p&idurale ~ 0,25 % (de I0 ~ 14 ml) et on a procddd ~ un blocage sensoriel bilat&al ~ la glace (-I-8 -I_4). On a prdlevd des &hantillons de sang avant le point dermique et ~ toutes les I0 minutes pendant une heure apt& le bloc afin de mesurer les concentrations plasmatiques de 13-endorphine, de cortisol, de glucose, de lactate et d'oxytocine. On n'a pas administrd d'oxytocine exog~ne. l'intensitd de la douleur a 6td dvalu6e au moment des prdl~vements sanguins en utilisant une &helle visuelle analogique (EVA) de 10 cm. La frdquence des contractions ut&ines a &d enregistr6e pendant 60 minutes avant et apr& I'analg6sie p&idurale. R&ultats : On a observd une baisse de la 13-endorphine plasmatique et des concentrations de cortisol apr& ranalg&ie p&idurale (P < 0,01). II n'y a pas eu de changements dans les concentrations de glucose et de lactate. La moyenne de rEVA pour la dou~eur a diminu~, I0 minutes apr~s le bloc p6ridural et est demeur& < 2 pendant toute la dur& de l'&ude (m < 0,00 I). Les concentrations moyennes d'oxytocine front pas changd. La frdquence...
Pmrpose:Two large studies reported a very low rate (0.5-1.8%) of postdural puncture headache (PDPI-I) with the use of 27-G spinal needes. We suspected that it might be higher in young ambulatory patients. The purpose of this study was to establish the rate prospectively in such a patient population using two types of needles. Methods:Two hundred male and female, outpatients, 18-45 yr, undergoing knee arthroscopy under spinal anaesthesia were randomly assigned to receive spinal anaesthesia with hyperbaric lidocaine 5% using either a Quincke or a Whitacre 27-G needle. Twenty patients choosing general anaesthesia formed a comparative group. Using a previously validated questionnaire, the incidence and nature of PDPH were evaluated by telephone three to five days after surgery by an anaesthetist unaware of the anaesthetic technique used. Once all data were collected, an anaesthetist not involved in the study determined in a blinded fashion which headaches were likely to be PDPH. Grading and classification of headaches were based on several criteria: postural nature, duration, intensity and confinement to bed. K~ults: The overall incidence of PDPH in both spinal groups was 9.3%. The incidence in women, 20.4%, was higher than in men, 5.5%, (P < 0.05). Only one patient required a blood patch. Both types of needle were comparable with respect to the incidence, severity and duration of PDPH, number of dural punctures and failed spinal blocks. Conclusion: The rate of PDPH was higher than in large published studies with 27-G Quincke and Whitacre needles and greater in women than in men. Objectif : Deux grandes series ont montr6 un taux tr~s has (0,5 -1,8 %) de c6phalEe post ponction durale (CPPD) avec I'emploi d'aiguilles de calibre 27. Nous avons Emis I'hypoth&e qu'il pourrait &re plus ElevE chez de jeunes patients ambulatoires. I'objectif de notre Etude &ait donc d'Etablir de fa~on prospective le taux de CPPD chez une telle population de patients en utilisant deux types d'aiguilles. M&hode : Deux cents hommes et femmes, patients ambulatoires de 18 ~. 45 ans, devant subir une arthroscopie du genou sous rachianesthEsie, ont EtE rEpartis au hasard pour recevoir une rachianesth&ie avec de la lidoca~ine hyperbare 5 % ~ I'aide d'une aiguille 27 Quincke ou Whitcare. Vingt patients, ayant choisi une anesth&ie gEnErale, ont formE un groupe tEmoin, Utilisant un questionnaire valid6 dans le pass6, rincidence et la nature des CPPD ont ~t~ Evalu~es par t~lEphone trois ~ cinq jours apr& la chirurgie par un anesth&iste qui ne connaissait pas la technique anesth&ique employee. Une lois que routes les donn6es ont &E recueillies, un anesth&iste non impliquE darts I'&ude a dEtermin~ d'une mani&e impartiale quelles &aient les cEphalEes qu'on pouvait &iqueter comme des CPPD. La cotation et la classification des c6phalEes ont &E basEes sur quelques crit&es : la nature posturale, la durEe, I'intensit~ et le confinement au lit. R~s~tats : I'incidence globale de CPPD des deux groupes sous rachianesth&ie a ~t~ de 9,3 %. I'incidence chez les femme...
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