Labor epidural analgesia onset time and subsequent analgesic requirements: a prospective observational single-center cohort study

Nevo, Amihay; Aptekman, Boris; Goren, Or; Matot, Idit; Weiniger, Carolyn F.

doi:10.1016/j.ijoa.2019.05.008

Cited by 2 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We chose an epidural loading dose of approximately 15 mL in all patients according to previous reports of EA, consisting of 6-7.5 mL of lidocaine or chloroprocaine followed by 8 mL of PIEB solution. 2,4 A lidocaine concentration of 1% was chosen according to a report by Shahram Nafisi. 20 Based on preliminary findings and reports in the literature, 6 mL of 1.5% and 7.5 mL of 1.2% chloroprocaine were the volumes and concentrations selected to explore an optimal volume and concentration with an equal total dosage (9 mg).…”

Section: Discussionmentioning

confidence: 99%

“…1 According to a recent study, a longer EA onset time significantly correlates with a higher pain score at 60 and 120 min and the administration of a greater number of patient-controlled EA (PCEA) boluses during the first 120 min. 2 Hence, studies exploring appropriate methods to shorten the onset time as much as possible are needed.…”

Section: Introductionmentioning

confidence: 99%

“…Various factors affect analgesia onset, such as the pharmacological and pharmacokinetic properties of local anesthetics, the infused concentration and volume, and the pH and temperature of the anesthetic solution. 2 In our clinical practice, 6 mL of 1% lidocaine is conventionally used for initiation followed by 8 mL of 0.08-0.125% ropivacaine plus sufentanil for a total loading dose consisting of 14-16 mL of solution. The mean EA onset time (time from the initial bolus to VAS score≤3) is approximately 15 min, which is significantly longer than that obtained with the combined spinal-epidural (CSE) technique and dural puncture epidural (DPE) technique.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

Zhu

Wang

et al. 2022

IJGM

View full text Add to dashboard Cite

This study aimed to explore the efficacy and safety of chloroprocaine for activating labor analgesia and the optimal concentration compared to lidocaine. Patients and Methods: Ninety-six nulliparous parturients were randomly assigned to three groups: LD group, patients received the conventional initial dose of 6 mL of 1% lidocaine; CP1.5 group, patients received 6 mL of 1.5% chloroprocaine as the initial dose; and CP1.2 group, patients received 7.5 mL of 1.2% chloroprocaine as initial dose. Labor analgesia was maintained in all patients via a programmed intermittent epidural bolus (PIEB). The primary outcome was the analgesia onset time. Secondary outcomes included the visual analog scale (VAS) scores, the interval and duration of uterine contractions during the first 12 contractions, failure to reach adequate analgesia, labor and neonatal outcomes, maternal satisfaction and adverse effects. Results: Parturients in the CP1.5 and CP1.2 groups achieved a shorter onset time than those in the LD group (hazard ratio (HR) = 6.540; 95% confidence interval (CI), 3.503-12.210; P < 0.001 and HR = 3.460; 95% CI, 1.905-6.282; P < 0.001, respectively). The median time (95% CIs) to adequate analgesia was 12.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

Zhu

Wang

et al. 2022

IJGM

View full text Add to dashboard Cite

show abstract

“…The pharmacokinetic studies have shown that alfentanil has a faster distribution rate in the epidural space than fentanyl and sufentanil, resulting in a faster analgesic effect [ 19 ]. Nevo et al [ 20 ] showed that the onset of epidural labor analgesia was significantly correlated with pain scores after 60 min, and longer analgesic onset, higher VAS at 60 and 120 min. In this study, there was no significant change in the uterine pressure at different time points.…”

Section: Discussionmentioning

confidence: 99%

The 90% effective concentration of alfentanil combined with 0.075% ropivacaine for epidural labor analgesia: a single-center, prospective, double-blind sequential allocation biased-coin design

Jia,

Zou,

Sun

et al. 2024

J Anesth

View full text Add to dashboard Cite

Purpose More literature studies have reported that alfentanil is safe and effective for labor analgesia. However, there is no unified consensus on the optimal dosage of alfentanil used for epidural analgesia. This study explored the concentration at 90% of minimum effective concentration (EC90) of alfentanil combined with 0.075% ropivacaine in patients undergoing epidural labor analgesia to infer reasonable drug compatibility and provide guidance for clinical practice. Methods In this prospective, single-center, double-blind study, a total of 45 singleton term primiparas with vaginal delivery who volunteered for epidural labor analgesia were recruited. The first maternal was administered with 3 μg/mL alfentanil combined with 0.075% ropivacaine with the infusion of 10 mL of the mixture every 50 min at a background dose of 3 mL/h. In the absence of PCEA, a total of 15 mL of the mixture is injected per hour. The subsequent alfentanil concentration was determined on the block efficacy of the previous case, using an up-down sequential allocation with a bias-coin design. 30 min after epidural labor analgesia, the block of patient failed with visual analog score (VAS) > 3, the alfentanil concentration was increased in a 0.5 μg/mL gradient for the next patient, while the block was successful with VAS ≤ 3, the alfentanil concentration was remained or decreased in a gradient according to a randomized response list for the next patient. EC90 and 95% confidence interval were calculated by linear interpolation and prediction model with R statistical software. Results In this study, the estimated EC90 of alfentanil was 3.85 μg/mL (95% confidence interval, 3.64–4.28 μg/mL). Conclusion When combined with ropivacaine 0.075%, the EC90 of alfentanil for epidural labor analgesia is 3.85 μg/mL in patients undergoing labor analgesia.

show abstract

Labor epidural analgesia onset time and subsequent analgesic requirements: a prospective observational single-center cohort study

Cited by 2 publications

References 17 publications

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

The 90% effective concentration of alfentanil combined with 0.075% ropivacaine for epidural labor analgesia: a single-center, prospective, double-blind sequential allocation biased-coin design

Contact Info

Product

Resources

About