Epidural anaesthesia and myomectomy-associated blood loss: — a prospective randomised controlled study

Farghali, Mohamed M.; Ibrahim, Abdelrady S; Farrag, Waleed Saleh

doi:10.5603/gp.a2021.0186

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…There are also few recently published studies on this topic. In 2019, a study revealed that the use of epidural analgesia during twin pregnancies can extend the second stage of labor for both twins, while in 2021, another study examined the impact of epidural analgesia on the delivery mode for the second twin and demonstrated a lower risk of cesarean section [6] , [7] However, in our study the exact reason for the increased proportion of epidural analgesia in twin pregnancies remains unknown due to the register-based study design. Confounding factors, such as higher maternal age and body mass index, gestational diabetes, and a higher proportion of instrumental vaginal deliveries (possibly requiring more pain relief in advance) among women with twin pregnancies might partly explain the higher proportion [13] , but the aORs still showed markedly increased odds for epidural analgesia among women with twin pregnancies.…”

Section: Discussionmentioning

confidence: 77%

“…However, a study published in 2019 found that epidural analgesia in twin pregnancies prolongs the second stage of labor in both twins [6] . In 2021, a study assessed the effects of epidural analgesia on the mode of delivery for the second twin and found that the risk for CS was reduced [7] . However, despite these findings, there are currently no reports on the use of different labor analgesia in twin pregnancies.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Vaajala,

Kekki,

Mattila

et al. 2023

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Vaajala,

Kekki,

Mattila

et al. 2023

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Farghali et al recently performed a prospective analysis of 343 parturients with twin gestation planned for a trial of vaginal delivery to determine the influence of EA on the delivery of the second twin [ 45 ]. The studied parturients received EA, while the control group consisted of parturients who received remifentanil-PCA on account of their ineligibility for EA.…”

Section: Discussionmentioning

confidence: 99%

“…Based on data from the previous study by Chadha et al [ 39 ], a sample size of 103 breech deliveries (37 with EA and 67 controls) would be sufficient to reach a statistical power of 0.8 with an α level of 0.05 when analyzing intrapartum CS rates. For twins, a sample of 10 births with EA and 50 with remifentanil-PCA would be sufficient to reach the same statistical power for intrapartum CS analysis based on data from Farghali et al [ 45 ]. Groups with remifentanil-PCA vs. EA were compared using the Chi-square test.…”

Section: Methodsmentioning

confidence: 99%

Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries

2023

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Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013–2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.

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“…It is important to also take into account about the myomectomy related blood loss and the anaesthesia provided. Farghali et al [4] studied epidural anaesthesia vs the myomectomy related blood loss and found that in patients whom general anaesthesia was provided there was more blood loss compared to whom epidural was administered. Hence this was an added advantage for us in already anemic patient.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of patient with severe aortic stenosis posted for Myomectomy: A case report

Mookambika¹,

Parthasarathy²

2022

Int. J. Med. Anesthesiology

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Aortic stenosis is a stenotic valvular heart disease with a fixed cardiac output state. The patients with such illness can come for non-cardiac surgeries. They pose significant challenges to the attending anesthesiologist. Here, we report a 45-year-old 65 kg female with significant aortic stenosis posted for myomectomy. She was a known case of significant aortic stenosis with an orifice of 1 sq.cm. She was symptomatic with NYHA class three symptoms. The patient had a difficult airway with Mallampatti class IV with stiff temporomandibular joints. The pulse rate was 70 / minute and regular with a blood pressure of 110/70mmHg. After explaining the pros and cons of General and regional anaesthesia, the patient accepted for a regional technique. A bilateral TAP block was administered with 20 ml of 0.25 % bupivacaine on each side. She was administered intrathecal fentanyl 50 µg with 0.5 ml of 0.5 % hyperbaric bupivacaine. Surgical anaesthesia was obtained and myomectomy was completed within 45 minutes. The blood loss was approximately 500 ml which was replaced. After an uneventful early postoperative period of six hours, she became hypotensive with a heart rate of 122/minute. An emergency ultrasound scan revealed a collection. A passive leg rising test was positive. She was again administered two more units of compatible blood. The rest of the postoperative period was uneventful and discharged on the seventh day. This case is reported for its extreme rarity and successful management.

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Epidural anaesthesia and myomectomy-associated blood loss: — a prospective randomised controlled study

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Ginekologia Polska" are listed in PubMed.

Cited by 3 publications

References 17 publications

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries

Anaesthetic management of patient with severe aortic stenosis posted for Myomectomy: A case report

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