Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness

Richardson, Michael G.; Lopez, Brandon M.; Baysinger, Curtis L.; Shotwell, Matthew S.; Chestnut, D.H.

doi:10.1213/ane.0000000000001680

Cited by 60 publications

(26 citation statements)

References 26 publications

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“…These demonstrate the relationship between patient satisfaction and the likelihood to receive neuraxial anesthesia in future. However, although analgesic effectiveness contributes to the satisfaction with labor analgesia care, it is not the only contributor to patient satisfaction [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

et al. 2018

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BackgroundEpidural analgesia is a popular choice for labour pain relief. Patient satisfaction is an important patient-centric outcome because it can significantly influence both mother and child. However, there is limited evidence in the correlations between clinical determinants and patient satisfaction. We aim to investigate clinical covariates that are associated with low patient satisfaction in parturients receiving labour neuraxial analgesia.MethodsAfter institutional ethics approval was obtained, we conducted a retrospective cohort study using electronic and corresponding hardcopy records from 10,170 parturients receiving neuraxial analgesia between the periods of January 2012 to December 2013 in KK Women’s and Children’s Hospital in Singapore. Demographic, obstetric and anesthetic data were collected. The patient satisfaction scores on the neuraxial labour analgesia was reported by the parturient at 24 to 48 h post-delivery during the post-epidural round conducted by the resident and pain nurse. Parturients were stratified into one of three categories based on their satisfaction scores. Ordinal logistic regression models were used to identify potential covariates of patient dissatisfaction.Results10,146 parturients were included into the study, of which 3230 (31.8%) were ‘not satisfied’, 3646 (35.9%) were ‘satisfied’, and 3270 (32.2%) were ‘very satisfied’. Multivariable ordinal logistic regression analysis showed that instrument-assisted vaginal delivery (p = 0.0007), higher post-epidural pain score (p = 0.0016), receiving epidural catheter resiting (p < 0.0001), receiving neuraxial analgesia at a more advanced cervical dilation (p = 0.0443), multiparity (p = 0.0039), and post-procedure complications headache (p = 0.0006), backache (p < 0.0001), urinary retention (p = 0.0002) and neural deficit (p = 0.0297) were associated with patient dissatisfaction. Chinese, compared with other ethnicities (p = 0.0104), were more likely to be dissatisfied.ConclusionsOur study has identified several clinical determinants that were independent associated factors for low patient satisfaction. These covariates could be useful in developing a predictive model to detect at-risk parturients and undertake time-sensitive precautionary measures for better patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

et al. 2018

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“…Nitrous oxide functions as a dissociative anesthetic [46]. Women rated nitrous oxide as less effective pain relief than epidural analgesia but satisfaction scores were similar [47].…”

Section: Con: Nitrous Oxide For Labor Analgesiamentioning

confidence: 99%

Pro-Con Debate: Nitrous Oxide for Labor Analgesia

Vallejo

Zakowski

2019

BioMed Research International

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This Pro-Con debate will provide the practitioner with an evidence-based knowledge approach to assist the clinician in determining whether to employ (Pro) or not to employ (Con) this technique in the obstetrical suite for labor analgesia. Nitrous oxide has been used safely in dentistry and medicine for many centuries. However, accumulating preclinical and clinical evidence increasingly suggests previously unrecognized adverse maternal and fetal effects of nitrous oxide, which warrants reconsideration of its use in pregnant women and a more detailed informed consent. Nitrous oxide is associated with metabolic, oxidative, genotoxic, and transgenerational epigenetic effects in animals and humans that may warrant limiting its usefulness in labor. This debate will discuss and review the clinical uses, advantages, and disadvantages of nitrous oxide on occupational effects of nitrous oxide exposure, neuroapoptosis, FDA warning on inhalational anesthetics and the developing brain, research limitations, occupational exposure safety limits, effects on global warming, and potential for diversion.

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“…Few good-quality studies have addressed labor analgesia with nitrous oxide, and research on effectiveness, satisfaction, and adverse effects is still needed. 95 Systemic opioid labor analgesia is widely used around the world; however, the use of narcotics in the obstetric setting has been associated with significant side effects and inferior efficacy when compared with neuraxial techniques. Remifentanil has been used for labor analgesia based on its short context-sensitive half-life.…”

Section: Anesthetic Implications Of Aplastic Anemiamentioning

confidence: 99%

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

Riveros-Pérez

Hermesch

Barbour

et al. 2018

IJWH

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Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.

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Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness

Cited by 60 publications

References 26 publications

Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

Pro-Con Debate: Nitrous Oxide for Labor Analgesia

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

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