Más de obstetricia / More on obstetrics

Mayo 18, 2018. No. 3084

Comparando el efecto de agregar fentanilo, sufentanilo y placebo con bupivacaína intratecal en la duración de la analgesia y las complicaciones de la anestesia espinal en pacientes programados para cesárea Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Farzi F1, Mirmansouri A2, Naderi Nabi B3, Atrkar Roushan Z4, Ghazanfar Tehran S5, Nematollahi Sani M6, Makhlooghi Azad S6, Nemati M6. Author information Anesth Pain Med. 2017 Aug 27;7(5):e12738. doi: 10.5812/aapm.12738. eCollection 2017 Oct. Abstract BACKGROUND: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. METHODS: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. RESULTS: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). CONCLUSIONS: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesareansection surgery. KEYWORDS: Bupivacaine; Cesarean Sections; Fentanyl; Spinal Anesthesia; Sulfentanil PDF Anestesia espinal continua para anestesia y analgesia obstétrica Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia. Veličković I1, Pujic B2, Baysinger CW3, Baysinger CL4. Author information Front Med (Lausanne). 2017 Aug 15;4:133. doi: 10.3389/fmed.2017.00133. eCollection 2017. Abstract The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques. KEYWORDS: intrathecal catheters; labor analgesia; neuraxial blockade; obstetric anesthesia; post-dural puncture headache; spinal catheters PDF El enfoque de control óptimo del dolor para el trabajo de parto: una revisión de la literatura actual. The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature. Kelly A1, Tran Q1. Author information Abstract Cureus. 2017 May 10;9(5):e1240. doi: 10.7759/cureus.1240. There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia. The use of various adjuvants such as opioids, clonidine, and neostigmine in conjunction with local anesthetics solution can significantly reduce the severity of motor blockade and the need for assisted vaginal delivery. KEYWORDS: labor analgesia; labor epidural; regional anesthesia PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org