Prior lumbar discectomy surgery does not alter the efficacy of neuraxial labor analgesia.

Background: Lumbar discectomy surgery is a common neurosurgical procedure. Neuraxial labor analgesia may be less effective in parturients with a history of discectomy surgery because of postsurgical scarring and anatomical distortion. In this prospective observational case-controlled study, we compared bupivacaine consumption per hour of labor analgesia as an indirect measure of labor analgesic effectiveness between women with prior discectomy surgery and those who did not have back surgery.

[The influence of patient-controlled epidural analgesia on labor progress and neonatal outcome].

Aim: The aim of the study was to check the influence of patient control epidural analgesia on labor progress and neonatal outcome.

Material And Methods: 144 parturients were included into the clinical trial. In 73 cases patient control epidural analgesia was used and in 71 cases pethidine (meperidine) solution was given intravenously.

Labor analgesia.

Regional analgesia has become the most common method of pain relief used during labor in the United States. Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space, and the patient receives a continuous infusion or multiple injections of local anesthetic.

Epidural technique for postoperative pain: gold standard no more?

Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only.

Effective delivery of pharmaceutical palliative care: challenges in the community pharmacy setting.

Background: Medication, particularly analgesia, is an important component of palliative care. However, timely access to medication, particularly opioids, can become problematic for patients receiving palliative care in the community setting. In Scotland in 2009, NHS Greater Glasgow & Clyde Health Board (NHS GG&C), in partnership with Macmillan Cancer Support, established a programme to improve the local provision of pharmaceutical palliative care services with the appointment of Macmillan Pharmacist Facilitators.

Epidural versus non-epidural or no analgesia in labour.

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant.

Objectives: To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour.

Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women.

Background: Programmed intermittent epidural anesthetic bolus (PIEB) technique may result in reduced total local anesthetic consumption, fewer manual boluses, and greater patient satisfaction compared with continuous epidural infusion (CEI). In this randomized, double-blind study, we compared the incidence of motor block and labor outcome in women who received PIEB or CEI for maintenance of labor analgesia. The primary outcome variable was maternal motor function and the secondary outcome was mode of delivery.

Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women.

Objective: To assess the risk for emergency cesarean section among women in whom labor was induced in gestational week ≥41 and to evaluate if parity and mode of induction affected this association.

Design: Hospital-based retrospective cohort study.

Population: Singleton pregnancies delivered after ≥41 gestational weeks at Danderyd Hospital, Stockholm, Sweden, during 2002-2006.

Maternal ambulation during labor.

Purpose Of Review: To describe the recent advances in labor epidural analgesia, which may have an impact on maternal ambulation during labor.

Recent Findings: With the advent of new epidural adjuvant drugs and new epidural delivery systems, we are now able to use very low concentration local anesthetic solutions with a reduction in the total doses of local anesthetic administered. This allows a much greater preservation of lower limb motor function in the parturient, with a subsequent positive effect on maternal ambulation.

Anesthetic management of spinal muscle atrophy type II in a parturient.

We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature.

Advances in labor analgesia.

The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum.

Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine.

Aim: To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine.

Material And Methods: This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer.

Horner's syndrome after lumbar epidural analgesia during labor.

Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose.

Epidural anesthesia: views and outcomes of women in labor in a Nigerian hospital.

Background: Pain during childbirth is a well known cause of dissatisfaction amongst women in labor. The use of epidural analgesia in labor is becoming widespread due to its benefit in terms of pain relief.

Method: After approval of the local Ethics Committee on Research and obtaining informed written consent, 50 American Society of Anesthesiologists (ASA) class I-II consecutive multiparous women in labor requesting pain relief were enrolled in this prospective study.

Epidural analgesia for labor pain: whose choice?

Objective: To test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit.

Design: Population-based cohort study.

Setting: All delivery units in Sweden.

Characteristics and practices of birth centres in Australia.

Background: Around 2% of women who give birth in Australia each year give birth in a birth centre. There is currently no standard definition of a birth centre in Australia.

Aims: This study aimed to locate all birth centres nationally, describe their characteristics and procedures, and develop a definition.

Births in two different delivery units in the same clinic--a prospective study of healthy primiparous women.

Background: Earlier studies indicate that midwife-led birth settings are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. The generalizability of these studies to birth settings with low intervention rates, like those generally found in Norway, is not obvious. The aim of the present study was to compare intervention rates associated with labour in low-risk women who begin their labour in a midwife-led unit and a conventional care unit.

[Use of ephedrine prefilled syringes reduces anesthesia costs].

Objective: The aim of the present study was to compare the consumption and cost of ephedrine in parturients with respect to two packagings: ampoules and prefilled syringes.

Study Design: Prospective observational study in a French university obstetrical unit.

Patients And Methods: Assessing the consumption and cost of ephedrine during two consecutive periods of 14 days: use of ampoules for period 1 (P1) versus use of prefilled syringes for period 2 (P2).

Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

Background And Objective: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice.

Comparison of 2% lignocaine with adrenaline and fentanyl, 0.75% ropivacaine and 0.5% levobupivacaine for extension of epidural analgesia for urgent caesarean section after low dose epidural infusion during labour.

Low dose local anaesthetic and fentanyl epidural solutions are commonly 'topped-up' for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ropivacaine 0.75% and levobupivacaine 0.

A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial.

Background: Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia.

Methods: Multiparous women in labour were randomised to receive either paracervical block or single-shot spinal analgesia.

[Quality indicator survey of anaesthesia records in hospitals of Aquitaine].

Objectives: Assessing the quality of anaesthesia records according to the criteria of the reference frame of professional practices evaluation proposed by the French Anaesthetists College (Cfar) in 2005.

Study Design: Retrospective, multicentric study.

Materials And Methods: Fifty anaesthesia records were randomly selected from each of the 64 health care settings in Aquitaine with an inpatient surgery activity.

The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice.

The conversion of epidural analgesia during labour to surgical anaesthesia for Caesarean section can have important medical and medicolegal implications. This survey sought to establish the current management for extending epidural blockade for emergency Caesarean section. A postal questionnaire was sent to the lead obstetric anaesthetist in all maternity units in the UK (n = 254).

Does epidural increase the incidence of cesarean delivery or instrumental labor in Saudi populations?

Background: This is a retrospective review of the medical records of 861 patients admitted for vaginal delivery. Patients were randomized to either epidural analgesia or other analgesic methods of pain relief for labor pains. The primary purpose of this study was to evaluate the effect of epidural analgesia on the rate of cesarean section delivery.

[Labor analgesia by one anesthesiologist in a small obstetric clinic].

In Japan, about 40% of all the parturients give birth in small obstetrician's clinics. There is no anesthesiologist in most clinics. The labor analgesia is not performed or is performed by the obstetrician in many facilities.