This prospective, blinded, randomized study compares the incidence of postdural puncture headache (PDPH) and the epidural blood patch (EBP) rate for five spinal needles when used in obstetric patients. One thousand two women undergoing elective cesarean delivery under spinal anesthesia were recruited. We used two cutting needles: 26-gauge Atraucan and 25-gauge Quincke, and three pencil-point needles: 24-gauge Gertie Marx (GM), 24-gauge Sprotte, and 25-gauge Whitacre. The needle for each weekday was chosen randomly. Cutting needles were inserted parallel to the dural fibers. The incidences of PDPH were, respectively, 5%, 8.7%, 4%, 2.8%, and 3.1% for Atraucan, Quincke, GM, Sprotte, and Whitacre needles (P = 0.04, chi(2) analysis), and the corresponding EBP rates in those with PDPH were 55%, 66%, 12.5%, 0%, and 0% (P = 0.000). The Quincke needle had a more frequent PDPH rate than the Sprotte or the Whitacre needle (P = 0.02) and a more frequent EBP rate than the GM, Sprotte, or the Whitacre needle (P = 0.01). The Atraucan needle had a more frequent EBP rate than the Sprotte or Whitacre needle (P = 0.05). Neither the PDPH rate nor the EBP rates differed among the pencil-point needles. The cost of EBP must be taken into consideration when choosing a spinal needle. We conclude that pencil-point spinal needles should be used for subarachnoid anesthesia in obstetric patients.

Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.

Although it has been suggested that epidural analgesia for labor contributes to an increase in neonatal sepsis work-up (SWU), this retrospective analysis shows that epidural analgesia is not associated with an increase in SWU. The factors that were found to contribute to SWU included low birth weight, low gestational age, meconium aspiration or respiratory distress at birth, hypothermia at birth, maternal group B beta-hemolytic colonization, and preeclampsia or hypertension.

Sixty obstetric patients were enrolled in the study to examine the possible effects of spinal anesthesia on their hearing. By using an audiometer, the patient's hearing was evaluated before delivery, after delivery, and for the following 2 days. There was no significant change of hearing in any of the patients.

Purpose: To compare analgesic efficacies of ropivacaine-fentanyl and bupivacaine-fentanyl infusions for labour epidural analgesia. Methods:In this double-blind, randomized study 100, term, nulliparous women were enrolled. Lumbar epidural analgesia (LEA) was started at cervical dilatation < 5 cm using either bupivacaine 0.25% followed by bupivacaine 0.125% + 2 µg·ml -1 fentanyl infusion (n=50) or ropivacaine 0.2% followed by ropivacaine 0 .1% + 2 µg·ml -1 fentanyl infusion (n=50). Every hour maternal vital signs, visual analog scale (VAS) pain score, sensory levels, and motor block (Bromage score) were assessed. Data were expressed as mean ± 1 SD and analyzed using Chi -Squared and Mann-Whitney U tests at < 0.05. Results:The onset times were 10.62 ± 4.9 and 11.3 ± 4.7 min for the bupivacaine and ropivacaine groups respectively (P = NS). The median VAS scores were not different between the groups at any of the evaluation periods. However, at least 80% of patients in the ropivacaine group had no demonstrable motor block after the first hour compared with only 55% of patients given bupivacaine (P =0.01).Conclusions: Both bupivacaine and ropivacaine produce satisfactory labour analgesia. However, ropivacaine infusion is associated with less motor block throughout the first stage of labour and at 10 cm dilatation.Objectif : Comparer l'efficacité analgésique des perfusions de ropivacaïne-fentanyl et de bupivacaïne-fentanyl pour l'analgésie péridurale pendant le travail obstétrical.Méthode : Cent femmes nullipares et à terme ont été recrutées pour participer à une étude randomisée et à double insu. L'analgésie péridurale lombaire (APL) a été amorcée quand la dilatation cervicale était < 5 cm en utilisant soit de la bupivacaïne à 0,25 % suivie de bupivacaïne à 0,125 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50), soit de la ropivacaïne à 0,2 % suivie de ropivacaïne à 0,1 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50). On a noté à toutes les heures : les signes vitaux de la mère, les scores de douleur à l'échelle visuelle analogique (EVA), les niveaux sensitifs et le bloc moteur (score de Bromage). Les données ont été exprimées en termes de moyenne ± un écart type et analysées d'après le test Chi 2 et le test U de Mann-Whitney à <0,05.Résultats : Les délais d'installation ont été de 10,62 ± 4,9 et de 11,3 ± 4,7 min pour la bupivacaïne et la ropivacaïne respectivement (P = NS). Les scores moyens de l'EVA n'ont pas affiché de différence intergroupe. Cependant, au moins 80 % des patientes qui ont reçu de la ropivacaïne n'avait pas de bloc moteur vérifiable après la première heure contrairement à 55 % seulement des patientes à qui on a donné de la bupivacaïne (P =0,01).Conclusion : La bupivacaïne et la ropivacaïne produisent une analgésie satisfaisante pendant le travail obstétrical. La perfusion de ropivacaïne est toutefois associée à un bloc moteur moins intense pendant la première phase du travail et à 10 cm de dilatation.

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In cases of unintentional dural puncture, exposure to neuraxial morphine for any reason may not be protective against the risk of postdural puncture headache. Although an overall protective effect of neuraxial morphine was not observed in this study, its role in specific subsets of patients remains to be investigated.