Dose-Dependent Reduction of the Minimum Local Analgesic Concentration of Bupivacaine by Sufentanil for Epidural Analgesia in Labor

Polley, Linda S.; Columb, Malachy O.; Wagner, Deborah; Naughton, Norah N.

doi:10.1097/00132586-199912000-00027

Cited by 22 publications

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“…Nicht nur Anästhesisten, sondern auch Ingenieure, Techniker, Chemiker und Psychologen stützen sich bei qualitativen Untersuchungen zu Material-, Wirkungs-und Dosierungsfragen u. a. auf die Methode der sequenziellen Zuordnung [45]. Dies bedeutet, dass im Untersuchungsverlauf die Zuordnung ("allocation") einer quantitativ veränderten Testvariablen im Verlauf der Untersuchung durch das Ergebnis des unmittelbar vorangehenden Tests bestimmt wird, der über eine Korrektur der Dosis nach oben ("up") oder unten ("down") entscheidet.…”

Section: Up-down Sequential Allocation Techniqueunclassified

“…Binäre Testresultate (ja/ nein, effektiv/ineffektiv) führen zu einer Kurve, die sich einem Medianwert in einem definierten und dadurch vorgegebenen Schritttempo annähert und schließlich um diesen oszilliert. Diese Untersuchungstechnik ist sehr effizient und kommt im Vergleich zu anderen randomisierten Untersuchungsmethoden mit einem um 30-80% kleineren Untersuchungskollektiv aus [15,16,45]. Aus methodologischen und ethischen Erwägungen wird bei der Bestimmung der MLAC prinzipiell von wirksamen Medikamentenkonzentrationen ausgegangen, die über der EC 50 liegen, so dass der Bereich der MLAC von oben her angesteuert wird [10].…”

Section: Up-down Sequential Allocation Techniqueunclassified

“…Die Technik der Up-down sequential allocation erlaubt nicht nur die Berechnung des Medianwerts, sondern auch die Bestimmung der 95%-Konfidenzintervalle (95%-CI) der EC 50 .Weitergehende Fragen zur MLAC-Bestimmung nach dieser Methode, zur statistischen Aufarbeitung der Resultate, Genauigkeit und Variabilität der Schätzwerte oder zur Gruppengröße, die für relevante Ergebnisse notwendig ist, werden im Anhang zur Publikation von Polley et al ausführ-lich dargestellt und kommentiert [45]. Dort findet sich auch eine Erklärung, warum Dosierungsintervalle bzw.…”

Section: Up-down Sequential Allocation Techniqueunclassified

“…Eine eindeutig dosisabhängige additive Wirkung epiduraler Opioide wurde hingegen in zwei weiteren Untersuchungen beobachtet [39,45]. In der klassischen Kombination von Bupivacain und Fentanyl [39] konnte dies ebenso wie in der Kombination mit Sufentanil [45] nachgewiesen werden.…”

Section: Einfluss Von Zusätzen Auf Die Mlacwerte Verschiedener Lokalaunclassified

“…In der klassischen Kombination von Bupivacain und Fentanyl [39] konnte dies ebenso wie in der Kombination mit Sufentanil [45] nachgewiesen werden. In der erst genannten Untersuchung [39] wurden 223 Schwangere unterschiedlicher Parität in fünf Studiengruppen eingeteilt: Die Gruppen erhielten entweder nur Bupivacain oder Bupivacain in Kombination mit Fentanyl in steigenden Dosierungen von 1, 2, 3 oder 4 µg/ml.…”

Section: Einfluss Von Zusätzen Auf Die Mlacwerte Verschiedener Lokalaunclassified

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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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Section: Up-down Sequential Allocation Techniqueunclassified

Section: Einfluss Von Zusätzen Auf Die Mlacwerte Verschiedener Lokalaunclassified

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Analgesie unter der Geburt

Mc¹

2002

Der Anaesthesist

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Epidural analgesia in labor: A narrative review

Halliday

Nelson

Kearns

2022

Intl J Gynecology & Obste

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Lumbar epidural is considered the gold standard for analgesia in labor and is recommended by WHO, with estimates of use in the range of 10%-64% in high-income countries. 1 During labor, uterine contraction and cervical dilatation stimulate nociceptive afferent fibers that travel to spinal nerves T10-L1, producing poorly localized visceral pain. As the fetal head descends, stretching the perineum and vagina, pain fibers via the pudendal nerve and spinal roots S2-4 are also activated. 2 To modify these afferent pathways and achieve analgesia, local anesthetics, opioids, and other adjuvants can be administered to the epidural space by an epidural catheter. Despite widespread use, there are many uncertainties regarding the optimal epidural regime. Different combinations and concentrations of drugs administered epidurally have been shown to have varying effects in both the partum and postpartum periods. With so many variables surrounding childbirth, it can be difficult to separate association and causation. Epidurals are associated with, but probably do not cause, prolonged labor and increased risk of operative delivery. 3 These factors directly affect obstetric decision making. For certain maternal conditions that may be decompensated by labor and delivery, such as pre-eclampsia or cardiac disease, labor epidural is indicated. In cases where epidural is contraindicated (such as severe thrombocytopenia, coagulopathy, or sepsis) other analgesic regimes (e.g. patient-controlled remifentanil) may be available.Improving communication and understanding between anesthetists and obstetricians is mutually beneficial. The aim of the present narrative review was to provide an overview of epidural literature for the obstetric audience, incorporating techniques of insertion, medications used, and associations with maternal and neonatal outcomes.Spinal anesthesia, and the use of epidural anesthesia for cesarean/ operative delivery are outwith the scope of the present review. | ME THODS | Search strategyA literature search without language restriction was conducted (MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, and Cochrane Central Register of Controlled Trials [CENTRAL]) from date of inception to October 5, 2020. Randomized controlled trials (RCTs), reviews, and relevant references were included. Search terms were "neuraxial analgesia," "epidural," "peridural," "combined spinal-epidural," "CSE,"

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Epidural analgesia and labor

O’Sullivan

2009

Eur Journal of Pain Supp

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Whilst women vary in their needs and desire for analgesia in labor it must be acknowledged that neuraxial analgesia is the only technique that can completely relieve the pain of labor. However the technique is not without its own inherent complications, both for the mother and for the process of labor and delivery. In this article the techniques for establishing and maintaining neuraxial analgesia in labor are discussed and the advantages and disadvantages of neuraxial analgesia in labor are explored.

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Dose-Dependent Reduction of the Minimum Local Analgesic Concentration of Bupivacaine by Sufentanil for Epidural Analgesia in Labor

Cited by 22 publications

References 0 publications

Analgesie unter der Geburt

Analgesie unter der Geburt

Epidural analgesia in labor: A narrative review

Epidural analgesia and labor

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