Continuous Peridural Anesthesia and Analgesia for Labor, Delivery and Cesarean Section.

Flowers, Charles E.; Hellman, Louis M.; Hingson, Robert A.

doi:10.1213/00000539-194901000-00048

Cited by 31 publications

(16 citation statements)

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“…It is interesting to note that in the beginning of the development of EDA, this method was used primarily to relieve pain during the 2 nd stage of labour. Flowers et al (1949) reported the first continuous epidural block for obstetrics using a plastic tube inserted into the epidural space. Intrathecal and caudal blocks were only superseded by EDA in the clinical practice, however, after commercial epidural catheters came into widespread use in the 1970s (Chadwick 2005).…”

Section: Epidural Analgesiamentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Section: Epidural Analgesiamentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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“…Hingson and his colleagues reported on the use of a plastic catheter in the epidural space in 1949. 10 With these developments and the improvement in epidural catheter manufacturing, the use of epidural analgesia for obstetrical practice increased over the next few decades.…”

Section: Dr Tuohy and His Needlementioning

confidence: 99%

Edward Tuohy: The man, his needle, and its place in obstetric analgesia

Martini

Bacon

Vasdev

2002

Regional Anesthesia and Pain Medicine

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“…Als Beispiel sei hier auf eine Untersuchung hingewiesen, in der auf der Basis des MLACModells die "Minimum Analgesic Dose" (MAD), die EC 50 von epiduralem Sufentanil in der Eröffnungsphase bestimmt wurde [8]. Bei spontanen Wehen betrug sie 22,2 µg (95%- CI 19,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]8), bei induzierten Wehen aber 27,3 µg (95%-CI 23, 9), ein signifikanter Unterschied. Ob sich die Technik der sequenziellen Dosisbestimmung nach dem Updown-Prinzip auch zur Beschreibung des Dosis-Wirkungs-Profils spinal verabreichter Pharmaka eignet, wird die Zukunft noch weisen müssen.…”

Section: Ausblickunclassified

“…Die lumbale Epiduralanalgesie konnte sich erst nach 1949 in der Geburtshilfe etablieren, nachdem Charles E. Flowers (1920Flowers ( -1999 die Kathetertechnik im Kreißsaal eingeführt hatte [21]. Dort verdiente sich die Epiduralanalgesie über die folgenden Jahrzehnte das Attribut eines Goldstandards und trat an die Stelle des Kaudalblocks, der 1909 von Walter Stöckel (1871-1961) erstmals vorgestellt [58] und 1942 von Robert A.…”

Section: Introductionunclassified

Analgesie unter der Geburt

Mc¹

2002

Der Anaesthesist

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Peripartum care of parturients has contributed a great deal to the development of modern anaesthesia during the past 150 years. The introduction of general and regional anaesthesia provided new options of relieving pain during delivery and preventing suffering. However,provision of effective labor analgesia gave and still gives rise to controversy as to whether interfering with natural events such as delivery was justifiable on a religious,moral or ideological level. A new era of obstetric pain relief was initiated when a study design was devised to define the Minimum Local Analgesic Concentration (MLAC) needed for epidural analgesia. Using the MLAC model as a scientifically based pharmacodynamic measure of analgesia, empirically developed "recipes" can be compared and validated. The importance of this clinical model will be put into a pharmacological context including issues such as the up-down sequential allocation technique, dose-response curves and differential nerve blockade.

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Continuous Peridural Anesthesia and Analgesia for Labor, Delivery and Cesarean Section.

Cited by 31 publications

References 0 publications

Intravenous patient-controlled analgesia with remifentanil in early labour

Intravenous patient-controlled analgesia with remifentanil in early labour

Edward Tuohy: The man, his needle, and its place in obstetric analgesia

Analgesie unter der Geburt

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