domingo, 5 de enero de 2014

Analgesia obstétrica/Obstetric analgesia

Efecto de la analgesia epidural con ropivacaína 0.075% versus ropivacaína 0.1% sobre la temperatura materna durante la labor: Estudio randomizado controlado

Effect of epidural analgesia with 0.075% ropivacaine versus 0.1% ropivacaine on the maternal temperature during labor: a randomized controlled study.

Yue HL, Shao LJ, Li J, Wang YN, Wang L, Han RQ.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2013 Nov;126(22):4301-5.
BACKGROUND: A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesiawith 0.075% or 0.1% ropivacaine on the maternal temperature during labor. METHODS:Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 µg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlledepidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes. RESULTS: Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation ofanalgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes. CONCLUSION:Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor

Una evaluación clínica de las bombas GemStar ® y de AmbIT® para analgesia epidural controlada por la paciente

A Clinical Evaluation of the GemStar® and the AmbIT® Pumps for Patient-Controlled Epidural Analgesia.
Sinha A, Paech M, Ledger R, McDonnell N, Nathan E.
Department of Anaesthesia, Queen Alexandra Hospital, Portsmouth, UK.
Anesth Pain Med. 2012 Fall;2(2):66-71. doi: 10.5812/aapm.7513. Epub 2012 Sep 13.
BACKGROUND: Patient-controlled analgesia is used for both labor and postoperative analgesia. OBJECTIVES: This study aimed to assess user satisfaction and functionality of two ambulatory, electronic patient controlled analgesia devices, the GemStar pump Hospira Inc., Illinois, USA) and the ambIT Ambulatory Infusion Therapy pump (Sorenson Medical Products, Utah, USA). PATIENTS AND METHODS: It was a randomized clinical trial of laboring women and postoperative gynecology patients receiving patient-controlledepidural analgesia. Patients were randomized to use one of the pumps and both anesthesiologists and patients completed questionnaires about aspects of pump function, and rated their satisfaction with the equipment. Midwives and high-dependency unit nurses also evaluated the pumps in each clinical setting. RESULTS: Forty patients, 20 laboring women and 20 postoperative patients were randomized and completed the study. The pumps were compared by nine anesthesiologists. Patient and staff satisfaction with both devices was high. Patient satisfaction did not significantly differ between groups (median 10 [8, 10] for the GemStar and 10 [9, 10] for the ambIT, P = 0.525]. The median staff satisfaction score was 8 [6, 8] for the GemStar and 7 [5, 8] for the ambIT (P = 0.154). Both patient cohorts rated each pump highly for most aspects of clinical function. Staff rated the ambIT pump more favourably with respect to portability and storage at the bedside whilst the GemStar had better assessments with respect to its consumables and interactions involving the electronic interface. CONCLUSIONS: Both devices were well-rated by patients and staff, with no significant difference between them for overall satisfaction, and only minor differences with respect to their respective strengths and weaknesses.
KEYWORDS: Analgesia, Epidural, Analgesia, Obstetrical, Analgesia, Patient-Controlled, Equipment and Supplies, Infusion Pumps

Analgesia epidural durante trabajo de parto versus no analgesia. Estudio comparativo

Epidural analgesia during labor vs no analgesia: A comparative study.

Mousa WF, Al-Metwalli R, Mostafa M.

Department of Anesthesia, Dammam University, Kingdom of Saudi Arabia.

Saudi J Anaesth. 2012 Jan;6(1):36-40. doi: 10.4103/1658-354X.93055.


BACKGROUND: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. METHODS: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. RESULTS: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. CONCLUSION: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

KEYWORDS: Anesthesia, epidural drug, lidocaine, obstetric technique;year=2012;volume=6;issue=1;spage=36;epage=40;aulast=Mousa;type=2

Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor

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