Neuraxial techniques of labour analgesia

Gupta, Sunanda; Partani, Seema

doi:10.4103/ija.ija_445_18

Cited by 26 publications

(18 citation statements)

References 37 publications

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“…[ 10 ] The practice of avoiding test dose and administering the first dose of labor analgesia is practised in obstetrics. [ 11 ] Saline pre-distension of epidural space with 2 ml versus 10 ml prior to test dose has reported wider dermatomal block in parturients. [ 12 ] However, our study population included only non-pregnant patients.…”

Section: Discussionmentioning

confidence: 99%

“…The large volume of saline that was used was based on the saline volumes with LOR to saline technique [ 9 ] or the pre-distension of epidural space in the obstetric population. [ 10 11 ] Perhaps, pre-distension or use of smaller volumes of saline of 3–4 ml may provide early sensory loss without undesirable haemodynamic side effects. This would be beneficial in elderly and frail population where haemodynamic changes are exaggerated.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

et al. 2020

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Background and Aims: Epidural analgesia is widely used for pain relief but confirmation of accurate epidural placement is poorly understood. We proposed that sensory blockade to cold sensation would predict the accurate placement of epidural. The primary outcome was the assessment of sensory blockade at 5 and 10 min with a standard epidural test dose versus test dose with additional saline. We looked at haemodynamic changes following administration as secondary outcomes. Methods: Following Ethics Committee approval, 161 patients presenting for elective abdominal surgery needing epidural analgesia with general anaesthesia were randomly allocated into Group 1 receiving standard test dose (3 ml of 2% lignocaine with 1:2,00,000 adrenaline) or Group 2 (standard test dose with 6 ml of saline) epidurally. The blockade to cold sensation was assessed at 5 and 10 min. The heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP) were recorded at baseline, 1, 5, and 10 min following epidural dosing. Statistical analysis was performed with Chi-square test for categorical and Student's t -test for continuous variables. Results: The sensory blockade at 5 min was 69.5% versus 82.3% ( P = 0.059), and at 10 min 85.4% versus 97.5% ( P = 0.01) in Groups 1 and 2, respectively. The MAP at 5 min ( P = 0.032) and the HR and MAP at 10 min ( P = 0.015, 0.04) were significantly lower in Group 2. Conclusion: An epidural test dose of 3 ml followed by additional 6 ml saline accurately predicted sensory blockade to cold at 10 min in comparison to the standard dose of 3 ml but was associated with a decrease in the HR and MAP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

et al. 2020

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“…After having gone through a period known as the "dark ages of obstetric anaestheisia" between the 1930s to the 40s, vast improvements in the safety of regional analgesia were made in the 1950s and advances continue to be made. 11,12 Studies from India on parturient's experience, satisfaction and factors affecting the same are but few, looking into various aspects like perceptions, expectations and attitudes. A study from Southern India concluded that analgesia is not always of primary importance but meeting the parturient's expectations plays a major role in parturient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Parturient satisfaction with labour epidural and factors affecting satisfaction scores: experiences from a tertiary centre in Southern India

George

Mani

Rai

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Labour analgesia though widely practised is still not routinely administered to all parturients in India. We conducted this historical observational cross-sectional study to assess parturient knowledge and factors affecting satisfaction in those who received epidural labour analgesia; aiming at improving the services.Methods: All parturients requesting epidural labour analgesia have the catheter sited and the drug administered as per institutional protocols. A feedback form is given to these parturients, postnatally. The form consists of questions regarding her knowledge of and experience with labour analgesia, including her satisfaction score on a scale of 0 to 10. Author collected these forms and analyzed them along with information from the labour epidural register and the discharge summary.Results: The mean satisfaction score was 7.1 (SD- 2.28). 46 parturients (31.08%) had ‘low satisfaction’ (<7 score) and 102 parturients (68.9%) had ‘high satisfaction’ (≥7 score). The timing of initiation of epidural analgesia within the parturients expectations and adequate analgesia were two factors that were found to affect satisfaction scores, with statistically significant values (p=0.002 and p=0.006 respectively). Those with a very short or very long duration of labour analgesia, were more likely to give less satisfaction scores (p=0.023 and p=0.002). Only 30% of parturients had heard of labour analgesia in the past.Conclusions: In this setting good analgesia and receiving it on time are of utmost importance in those receiving epidural labor analgesia, emphasising the need for adequate analgesia and prompt initiation of the same.

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“…There are various methods to mitigate labor pain, including pharmacological and non-pharmacological methods. Pharmacological methods involve using Entonox, systemic opioids, and regional methods (5,6). Regional analgesia involves spinal, epidural, and combined spinal-epidural methods that apply to induce analgesia in labor (7,8).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial

et al. 2020

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Background: Labor pain is a severe pain, and intrathecal opioid injection is one of the analgesia methods to reduce it. Objectives: We assessed the effects of intrathecal Fentanyl and Sufentanil on the onset, duration, and quality of analgesia for labor analgesia. Methods: In this double-blind, randomized clinical trial, 54 healthy nulliparous women 18 - 45 years in the active phase of labor who were requesting labor analgesia were enrolled in two groups fentanyl (F) and sufentanil (S). Patients received 75 µg fentanyl or 7.5 µg sufentanil intrathecally in the fentanyl group (n = 27) and the sufentanil group (n = 27), respectively. Pain relief, onset, duration of analgesia, hemodynamic parameters, patients' satisfaction, and neonatal Apgar score were assessed in this study. Data were analyzed by using SPSS16. Results: There were no significant differences between the groups in terms of demographic and hemodynamic parameters. The onset time of analgesia was 5.6 ± 4.3 and 3.6 ± 2.1 minutes, in the sufentanil and fentanyl groups, respectively (P = 0.037). The duration of analgesia was higher in patients who received sufentanil than those who received fentanyl (113 ± 45 vs. 103 ± 22 minutes (P = 0.629)). The pain score in the Fentanyl group was significantly lower at 5, 10, and 15 minutes after spinal analgesia (P < 0.05). The sedation score at 1 and 5 minutes was significantly higher in the fentanyl group than the sufentanil group (P < 0.05). The frequency and severity of pruritus and satisfaction rate in the fentanyl group were significantly higher than the sufentanil group. Conclusions: Intrathecal fentanyl and sufentanil have a similar analgesic effect on labor. Fentanyl is associated with a faster onset of analgesia and more satisfaction, while sufentanil has longer analgesia.

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Neuraxial techniques of labour analgesia

Cited by 26 publications

References 37 publications

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries

Parturient satisfaction with labour epidural and factors affecting satisfaction scores: experiences from a tertiary centre in Southern India

Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial

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