A randomised controlled trial of fluid pre-loading before low dose epidural analgesia for labour

Kubli, M; Shennan, Andrew; Seed, Paul; O’Sullivan, Geraldine

doi:10.1016/s0959-289x(03)00071-2

Cited by 26 publications

(14 citation statements)

References 16 publications

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“…This issue was addressed recently by investigators from St Thomas' Hospital in London [23]. Prior to low-dose epidural analgesia (bupivacaine 0.1% with fentanyl) patients received either no i.v.…”

Section: Combined Spinal Epidural Analgesia and Hypotensionmentioning

confidence: 99%

Neuraxial analgesia and fetal bradycardia

Velde

2005

Current Opinion in Anaesthesiology

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Section: Combined Spinal Epidural Analgesia and Hypotensionmentioning

confidence: 99%

Neuraxial analgesia and fetal bradycardia

Velde

2005

Current Opinion in Anaesthesiology

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“…Recent investigators questions the relevance of fluid preloading in current epidural practice because they were not able to show a statistically significant increase in the incidence of maternal hypotension when intravenous preloading was omitted before labor epidural using a low concentration bupivacaine. 64,65 A study by Kinsella et al also showed similar findings using a low concentration bupivacaine during labor epidural. 66 However, new abnormalities in FHR tracing occurred in 11% and 30% of the preload and no preload groups, respectively.…”

Section: Fluid Preloadingmentioning

confidence: 68%

Progress in analgesia for labor: focus on neuraxial blocks

Ranasinghe

Birnbach

2009

IJWH

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Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.

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“…[6] Prehydration or preloading is commonly administered but it has controversial results. [7,8] Despite all conservative measures, a vasopressor drug is oft en required to prevent hypotension during spinal anesthesia. [13] In this study, all patients in the two groups were comparable with respect to age and ASA status.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Prehydration or preloading is commonly administered but it has controversial results. [7,8] Because of the poor effi cacy of nonpharmacological techniques to eff ectively manage hypotension, a vasopressor is usually required during spinal anesthesia for cesarean section. In choosing an appropriate vasopressor in obstetrics, a number of factors like efficacy for maintaining blood pressure, noncardiovascular maternal eff ects, ease of use, direct and indirect fetal eff ects, cost, and availability need to be considered.…”

Section: Introductionmentioning

confidence: 99%

Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section

Nazir

Bhat

Qazi

et al. 2012

J Obstet Anaesth Crit Care

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Background: Maternal hemodynamic changes are common during spinal anesthesia for cesarean delivery. Many agents are used for treating hypotension. In this study we compared the effi cacy of ephedrine and phenylephrine in preventing and treating hypotension in spinal anesthesia for cesarean section and their effect on fetal outcome. Materials and Methods: A total of 100 ASA Grade I patients undergoing elective cesarean section under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were randomly allocated into two groups of 50 each. Group I received prophylactic bolus dose of ephedrine 10 mg IV at the time of intrathecal block with rescue boluses of 5 mg. Group II received prophylactic bolus dose of phenylephrine 100 g IV at the time of intrathecal block with rescue boluses of 50 g. Hemodynamic variables like blood pressure and heart rate was recorded every 2 minutes up to delivery of baby and then after every 5 minutes. Neonatal outcome was assessed using Apgar score at 1 and 5 minutes and neonatal umbilical cord blood pH values. Results: There was no difference found in managing hypotension between two groups. Incidence of bradycardia was higher in phenylephrine group. The differences in umbilical cord pH, Apgar score, and birth weight between two groups were found statistically insignifi cant. Conclusion: Phenylephrine and ephedrine are equally effi cient in managing hypotension during spinal anesthesia for elective cesarean delivery. There was no difference between two vasopressors in the incidence of true fetal acidosis. Neonatal outcome remains equally good in both the groups.

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A randomised controlled trial of fluid pre-loading before low dose epidural analgesia for labour

Cited by 26 publications

References 16 publications

Neuraxial analgesia and fetal bradycardia

Neuraxial analgesia and fetal bradycardia

Progress in analgesia for labor: focus on neuraxial blocks

Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section

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