Modern techniques to optimize neuraxial labor analgesia

Nanji, Jalal A.; Carvalho, Brendan

doi:10.17085/apm.2018.13.3.233

Cited by 5 publications

(3 citation statements)

References 68 publications

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“…Besides, CSE provides better quality analgesia throughout labor. [ 16 ] Our results are in line with previous studies,[ 13 17 18 ] which found no difference in physician top-up boluses between CSE and EPL techniques. In contrast, one study[ 19 ] showed more physician top-up boluses with CSE (36%) versus epidural (27%).…”

Section: Discussionsupporting

confidence: 92%

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A randomized comparison of epidural, dural puncture epidural, and combined spinal-epidural without intrathecal opioids for labor analgesia

Bakhet

2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Dural puncture epidural (DPE) has been shown to improve labor analgesia over epidural (EPL), with fewer side effects than a combined spinal-epidural (CSE). However, there is some debate regarding the superiority of DPE over EPL and CSE. Therefore, we aimed to compare the effects of EPL, DPE, and CSE without intrathecal opioids on the epidural local anesthetic (LA) consumption and occurrence of side effects in early labor. Material and Methods: We randomly assigned parturient to one of the 3 groups; EPL, DPE, or CSE. EPL and DPE groups received a 10 mL loading dose of 0.1% bupivacaine with fentanyl 2 μg/mL. CSE group received intrathecal 2.5 mg bupivacaine (without opioids). Labor analgesia was maintained in all patients via patient-controlled epidural analgesia (PCEA). The primary outcome was the mean hourly consumption of epidural LA. Results: The mean hourly consumption of epidural LA anesthetic was significantly lower in CSE (9.55 mL), compared with the EPL (11 mL), and DPE (10.5 mL), P < 0.01; but no significant difference was seen between EPL and DPE. Compared with EPL and DPE, CSE achieved faster time to complete analgesia defined as a numeric rating pain scale (NRPS) ≤1 and sensory block, lower NRPS in the first hour and higher frequencies of complete analgesia. There were no differences between groups in terms of physician top-up boluses, the occurrence of side-effects, mode of delivery, Apgar scores, and maternal satisfaction. Conclusion: Compared with EPL and DPE, CSE without intrathecal opioids, had a less epidural LA consumption, faster onset of analgesia, with no difference in the incidence of side effects. Trial Registration: This study was registered at www.clinicaltrials.gov (NCT03980951).

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Section: Discussionsupporting

confidence: 92%

“…Another objection to the use of CSE is an increased incidence of hypotension, fetal bradycardia, nausea, and vomiting. [ 16 22 ] However, our results agree with previous studies[ 14 22 ] which failed to find a significant difference between CSE and EPL.…”

Section: Discussionsupporting

confidence: 92%

A randomized comparison of epidural, dural puncture epidural, and combined spinal-epidural without intrathecal opioids for labor analgesia

Bakhet

2021

Journal of Anaesthesiology Clinical Pharmacology

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“…The medication and techniques for labor analgesia in obese parturients are not significantly different from those in mothers of normal weight. Patient-controlled epidural analgesia (PCEA) and programmed intermediate epidural boluses are widely used and dilute low concentrations of local anesthetics ( < 0.1% bupivacine or equivalent potency of ropivacaine) mixed with opioids (fentanyl or sufentanil) are recommended as medications [30].…”

Section: Analgesia For Labormentioning

confidence: 99%

Anesthetic management of obese and morbidly obese parturients

Kim

2021

Anesth Pain Med

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The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

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