Epidural Analgesia For Pain Relief Research Articles

The Occurrence and Factors Associated with Overt Urinary Retention Among Postpartum Women After Vaginal Delivery with Labor Epidural Analgesia.

Early recognition and prompt intervention for overt postpartum urinary retention (PUR) takes on a critical significance when a woman chooses labor epidural analgesia for pain relief. However, there have been rare fewer reports on the incidence and factors influencing overt PUR in women after vaginal delivery with labor epidural analgesia in China. Therefore, this study aimed to investigate the incidence and factors correlated with overt urinary retention in postpartum women undergoing vaginal delivery with labor epidural analgesia. In total, 462 Chinese postpartum women with labor epidural analgesia and vaginal delivery were recruited in one tertiary hospital in Beijing from Dec. 2020 to Nov. 2021. Factors associated with overt PUR for these women were identified through multivariate logistic regression analysis. The incidence of overt PUR was obtained as 10.2% among these women after vaginal delivery with labor epidural analgesia. As indicated by the result of univariate analysis, forceps-assisted delivery, lateral episiotomy, perineal pain, and fluid administration in the delivery room were correlated with PUR. The result of the multivariate logistic regression suggested that forceps-assisted delivery (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.14-5.32, P=0.022), lateral episiotomy (OR=4.55, 95% CI: 1.91-10.80, P=0.001), and perineal pain (OR=4.23, 95% CI: 2.05-8.73, P<0.001) were factors affecting overt PUR for these women. Postpartum women undergoing vaginal delivery with labor epidural analgesia showed a high incidence of overt PUR, and health-care providers should pay more attention to their postpartum urination status in clinical practice. Effective and timely intervention is strongly recommended to reduce the occurrence of overt PUR for these kinds of postpartum women undergoing vaginal delivery with labor epidural analgesia, such as ones experienced forceps-assisted delivery, lateral episiotomy, and more severe perineal pain.

Factors Affecting Women's Attitudes Toward the Use of Epidural Anesthesia During Labor in Riyadh in 2023.

Background Epidural analgesia (EA) is a type of central nerve block achieved by injecting a local anesthetic near the pain-transmitting nerves. It is commonly used to relieve pain during labor. The intensity of pain experienced and the effectiveness of pain relief can affect a woman's labor and delivery experience. Labor pain is a long-lasting and debilitating pain that women experience; therefore, pain relief techniques have become widely available. However, not all women are willing to use EA for pain relief. The factors that influence women's choices regarding EA should be explored. This study aimed to comprehend women's perspectives on EA in Riyadh and clarify the variables influencing their decision-making. Methodology A total of 336 women in their reproductive years participated in this study. An online questionnaire with five sections was used to collect data. The socio-demographic information in the first section covered age, level of education, occupation, income, marital status, pregnancy, maternity, and prenatal care. The second section focused on how painful labor was for women who had already given birth. The third and fourth sections discussed labor pain relief techniques, including epidural anesthesia. The final section assessed the participant's interest in receiving EA during the next delivery. Socio-demographic data were considered to be a predictor, whereas awareness levels and a desire to receive EA were seen as results. The information was cleaned, coded, and entered into SPSS version 29 (IBM Corp., Armonk, NY, USA). The results are presented as frequencies and percentages. A Likert scale was used for data analysis. Statistical significance was established at p-values <0.05. Results In total, 336 Saudi women were included in this study, 86% of whom were between the ages of 30 and 35 years, and 69% of whom had a university education. One-third of the women (32%) had a monthly income of 10,000 to 20,000 SAR, and 55% of them had experienced three or more pregnancies. Fear of pain was the main reason for using epidural anesthesia in more than half of the participants given the choice. The most reinforcing factor was obtaining proper and sufficient information about EA, while the most restrictive factor was the fear of harming the infant. In particular, women aged 30-35 years (i.e., most of the included women) were commonly influenced by negative factors. Marital status and educational level played no significant role in women's use of EA. Conclusions Saudi women showed a good attitude toward EA. However, the awareness of EA was quite low. Fear of labor pain appeared to be the main reason for using EA. Health education programs on EA can increase the knowledge of and intent to use EA among women.

Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project

BackgroundIn 2015, a quality improvement project—the “Adequate Childbirth Project” (Projeto Parto Adequado, or PPA)—was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals.MethodsCross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test.Results4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including “oral fluid and food”, “maternal mobility and position”, “monitoring of labor”, “use of non-pharmacological methods for pain relief” and “epidural analgesia for pain relief” in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors.ConclusionsThere was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.

A Protocol on Comparative Evaluation of Epidural and Spinal Technique of Labour Analgesia in Rural Women of Central India and their Perceptions Regarding Pain Relief in Labour

Background: Labour pain while giving birth is one of the most excruciatingly painful and emotionally stressful experience for a woman that has piqued the interest of several academicians. Labour pain is induced due to the uterine ischemia, expansion of vagina and birth canal, muscle contractions, and pressure on the bladder. To relieve the severe pain during labour, analgesia is required, which offers pain relief without the loss of consciousness. Regional analgesia (Epidural and spinal) are most commonly used for offering pain relief to women.&#x0D; Aim: To evaluate whether low dose spinal analgesia is a better alternative to lumbar epidural analgesia for pain relief in labour.&#x0D; Objectives - Primary objective is to evaluate efficacy of lumbar epidural and spinal analgesia for pain relief in labour. Secondary objective is to evaluate the perceptions of women towards the use of labour analgesia, to evaluate the maternal and fetal outcome and to evaluate the barriers affecting the use of lumbar epidural and spinal analgesia for women during labour.&#x0D; Methods: In this randomized control trial study, where 60 patients are present in each group. Patients in GROUP E, epidural analgesia will be given using 18-gauge Touhy epidural needle by a loss of resistance to air technique, and after confirmation of space, an epidural catheter will be inserted cranially in L3 - L4 or L4-L5 interspace, and a dose of 15ml of 0.125% bupivacaine with 25µg of fentanyl would be given slowly. Group S patients will receive subarachnoid block using 25-gauge needle inserted and directed to reach the intrathecal space between L3 - L4 or L4 - L5 intervertebral space. After a successful Dural puncture with acceptable CSF flow, 0.1% bupivacaine 2ml with 25µg fentanyl will be given via spinal needle. Throughout the duration of delivery, hemodynamic monitoring including SPO2, ECG, heart rate and blood pressure of mother and fetal heart rate would be monitored under the guidance of obstetrician and anesthesiologists. Patient will be assessed every 5min for the first 15 min, and then every 15 minutes until additional analgesia was requested. The severity of labour pain would be assessed using visual analogue scale. (0 = no pain; 10 = severe pain). Within the first 24 - 48 hours postpartum patient will fill the self-administered questionnaires.&#x0D; Results: The groups are expected to be similar. However, Low dose spinal analgesia may be a better alternative to lumbar epidural analgesia in providing effective pain relief for women in labour in terms of cost effectiveness. There are no results found as it is just a protocol. Results are yet to come.&#x0D; Conclusions: The study would offer new insights and knowledge into the use of epidural and spinal analgesia in India, particularly Wardha. The perceptions of women, towards labour analgesia, its consequences or side effects, and the myths associated with its use will be comprehended.

Maternal Hypotension and Tachysystole Following Neuraxial Anesthesia: Effect on Fetus in Labor.

Maternal Hypotension and Tachysystole Following Neuraxial Anesthesia: Effect on Fetus in Labor.

Statistics on Epidural Analgesia Made on Admitted Patients for Normal Vaginal Delivery, Outcome Results and Benefits

Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient. Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery. Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were approached for the consenting process, and those who agreed to participate in the study were included in the analysis. Patients were stratified in two groups based on the type of pain control they opted for/received at the time of admission: epidural delivered anesthesia or intravenous infusion of pain medications. Results: A 100 eligible women consented to take part in the study, between January 1st, 2020 and December 31st, 2020. Maternal and fetal survival at the 30-days mark was 100.0% for both groups. Duration of labor was significantly 0.1h shorter in the epidural group with a mean of 6.7 ± 1.8 h as opposed to 6.8 ± 2.6 h in the nonepidural group. Use of forceps and/or vacuum was significantly higher in the epidural group 9 (17.3%) and 2 (3.8%) as opposed to 1 (2.1%) and 0 (0.0%) in the epidural group. A higher rate of severe perineal tears (grade 3 or more) was observed in women who received epidural anesthesia. Conclusion: Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU. Epidural anesthesia however remains a risk factor for AVD and thus the use of instruments Its role as for severe perineal lacerations remains unclear according to our data, as we did not account for confounding factors. This last point remains to be investigated in large population-based studies.

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes.

Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

Sociodemographic Factors Associated with Request for Labor Epidural Analgesia in a Tertiary Obstetric Hospital in Vietnam.

This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.

Epidural analgesia during labour and stress markers in the newborn

Labour and modes of delivery can influence the plasma levels of stress hormones and cytokines involved in pathophysiologic cascade, potentially damaging brain development of the newborn. This prospective observational, single-centre, case-control, non-profit study aimed to detect potential differences in foetal well-being such as stress neuroendocrine responses. Quantitative determinations of the stress markers interleukin (IL)-1β, IL-8, and β-endorphin were compared between the control group and the epidural analgesia group. We found higher IL1-β levels but lower IL-8 and β-endorphin levels in the epidural analgesia group than in the control group. No significant inter-group differences were observed for any parameters. Our findings demonstrate that epidural analgesia for pain relief during labour does not result in significant differences in blood stress response markers. IMPACT STATEMENT What is already known on this subject? We already know that plasma levels of stress hormones and cytokines are influenced by labour and delivery modes. This has a deep impact on the newborn in terms of brain damage, immune system deficits, and altered hypothalamic-pituitary axis responses. We also know that epidural analgesia is a widespread practice that offers pain relief to the woman in labour, but there are few studies on the potentially negative effects of epidural labour analgesia on the unborn child. What do the results of this study add? This study found no significative differences in blood stress response markers between the epidural analgesia group and the control group. Under this study circumstances we found out that epidural analgesia does not significantly influence the newborn’s well-being during labour and delivery. What are the implications of these findings for clinical practice and/or further research? These findings must be confirmed by further studies to verify whether epidural analgesia is safe for the newborn’s development.

The association between labor epidural analgesia and postpartum depression: a systematic review and meta-analysis

BackgroundPrevious studies have demonstrated that appropriate treatment for postoperative pain can lead to improvement in depressive symptoms, however the association between adequate intrapartum pain control and the development of postpartum depression is not clear. The purpose of the study was to examine the effects of labor epidural analgesia and postpartum depression.MethodsWe performed a quantitative systematic review in compliance with the PRISMA statement. We conducted a search of PubMed, Embase, the Cochrane Database of Systematic Reviews and Google Scholar databases. The primary outcome was a positive screen of postpartum depression among women who received labor epidural analgesia up to 3 months into the postpartum period. Meta-analysis was performed using the random effect model.ResultsOf the 148 studies available, 9 studies with 4442 patients were included in the analysis. The use of labor analgesia on positive depression screen compared to control revealed no significant effect, OR (95% CI) of 1.02 (0.62 to 1.66, P = 0.94).ConclusionBased on current literature, the use of epidural analgesia for pain relief during labor doesn’t appear to affect the likelihood of postpartum depression. Future studies are warranted to further investigate these findings and identity other possible preventative interventions that reduce postpartum depression.

Position in the second stage of labour for women with epidural anaesthesia.

Position in the second stage of labour for women with epidural anaesthesia.

The Outcome Analysis of Epidural Analgesia on Labor in Primigra vid Women: A Systematic Review and Meta-Analysis Focusing on Durati on of Labor

Background: Epidural anesthesia is extensively used worldwide for pain relief in labor and more lately as an alternative and preferred form of anesthesia for caesarean sections; although its use is gaining universality, its outcome on the duration of labor is still debatable. Our meta-analysis aimed at analyzing the effects of epidural analgesia on duration of labor in primigravid women focusing on duration of labor. Methods: We conducted a systematical literature search in PubMed and Embase (from the inception to July 2016). We calculated weighted mean differences (WMD) between the groups for continuous data, and corresponding 95% confidence intervals (CIs) using the random-effects model. We also performed a subgroup analysis for the effects of different types of studies on duration of labor. Statistical heterogeneity amongst the included studies was tested by I2 indicator. Results: Twelve studies, recruiting 16200 mothers overall, were selected for this systematic review and metaanalysis. The duration of first stage of labor was significantly prolonged in the epidural group by a mean of 2.66 (0.89, 4.43, p<0.00001) and significantly shortened the second stage of labor by a mean of -12.79 (-21.13, -4.45, p<0.00001). Moreover, the overall subgroup analyses shown significantly prolongation of the first stage of labor by the same mean of 2.66 (0.89, 4.43, p<0.00001). Conclusion: The use of epidural analgesia for pain relief during labor is associated with prolongation of first stage of labor and does not prolong the second stage of labor.

Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour.

Approximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of 'normal' labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context. To examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth. Ethnography, underpinned by a critical medical anthropology methodology. These findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence. As we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a 'risky' practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more 'dangerous' option.

Measuring and improving the quality of postoperative epidural analgesia for major abdominal surgery using statistical process control charts

To explore and improve the quality of continuous epidural analgesia for pain relief using Statistical Process Control tools. Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief. Process control and quality improvement Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain. The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions. Statistical Process Control is a useful tool for measuring and improving the quality of pain management. The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that has led to the establishment of a national pain registry.

Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement

Background:Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.Aims:Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.Settings and Design:Randomised, controlled, non-blinded study done in a tertiary care private hospital.Methods:Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.Statistical Analysis:Mean VAS score at 6, 6–24, 24–48 and 48–72 h were considered. Significance was assessed at the 5% level.Results and Conclusion:VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.

Maternal Temperature Elevation and Occiput Posterior Position at Birth Among Low‐Risk Women Receiving Epidural Analgesia

To evaluate the relationship between maternal temperature elevation and occiput posterior position at birth as well as the association of fetal head position and temperature elevation on method of birth among women receiving epidural analgesia. We conducted a secondary analysis of data from the Fetal Orientation during Childbirth by Ultrasound Study (FOCUS), which used serial ultrasounds to evaluate the effect of epidural anesthesia on fetal position at birth in low-risk women. The current analysis was limited to the 1428 study participants who received epidural analgesia. In our population, 47% (n = 669) of women had a maximum intrapartum temperature greater than or equal to 99.6°F (37.6°C). The prevalence of fetal occiput posterior position at admission did not differ between women who later developed temperature elevations (24.4%) and those who did not (23.6%, P= .70). Women who developed an elevated temperature greater than or equal to 99.6°F (37.6°C) had an increased risk of occiput posterior fetal head position at birth regardless of the amount of temperature elevation (odds ratio [OR]= 2.0; 95% confidence interval [CI], 1.5-2.8); the association persisted after control for potentially confounding factors (adjusted OR = 1.5; 95% CI, 1.1-2.1). The cesarean birth rate among women with both temperature elevation and occiput posterior position at birth was more than 12 times the rate of women with neither risk factor (adjusted OR = 12.6; 95% CI, 7.5-21.2). Intrapartum temperature elevation among women receiving epidural analgesia, even if only to 99.6°F (37.6°C), is associated with approximately a 2-fold increase in the occurrence of occiput posterior fetal head position at birth. Additionally, although this observational study cannot establish causal links, our findings suggest that the relationship between epidural-related intrapartum temperature elevation and occiput posterior position at birth could contribute to an increased cesarean birth rate among women receiving epidural analgesia for pain relief in labor.

Body Art Causing Radiological Artifact: A Case Study

An otherwise healthy 26-year-old pregnant woman in active labor requested epidural analgesia for pain relief. Her history was significant for scoliosis, having undergone surgical correction with Harrington rods in the thoracic spine 10 years earlier. A well-healed midline surgical scar was apparent between her scapulae. The lumbar area of the back was free of any obvious surgical scars. She offered spine radiographs, taken 5 years earlier, to confirm location of surgical hardware. Examination of the radiographs (Figure 1) did indeed confirm thoracic spinal hardware, but also raised concern for possible lumbar spinal instrumentation, which could potentially complicate the epidural anesthetic. On further questioning, a piece of dangling navel jewelry, also known as a ‘‘belly button’’ ring, was the cause for this radiological artifact. Epidural analgesia for her labor proceeded without difficulty. The practice of body piercing and tattooing goes back to ancient civilizations. Historically, body art was often considered deviant or rebellious behavior, relegated to a nonmainstream segment of the population. However, recent data indicate that this practice has spread throughout all socioeconomic classes and age groups (Laumann & Derick, 2006; Stirn, 2003). The popularity of body art has increased in prevalence over recent years with some data suggesting 25% to50%of the population with some form of body art, either piercings (other than

Prise en charge anesthésique d’un accouchement chez une patiente atteinte d’un déficit en inhibiteur de C1 estérase

Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows.

Effects of Epidural Anesthesia on Labor Progress

Abstract Although delivery is a normal physiologic process, it causes a certain level of pain in women. Today, the most frequently preferred and the most used method is epidural anesthesia. The objective of the present study was to review the reasons, effects, and risks associated with epidural analgesia for pain relief. The study was conducted at Akdeniz University Hospital, Antalya, Turkey, between October 2004 and July 2005. Epidural analgesia was administered to 51 pregnant women in the experimental group, and 51 pregnant women in the control group did not receive analgesia. Data were collected by questionnaire and observation forms. Epidural anesthesia was chosen by 76.5% of the participants because they wanted to experience a pain-free childbirth, 66.7% because they were afraid of the process of delivery, 25.5% because they had had a previous bad labor experience, 35.3% because they had people around them with positive experiences, 29.4% because they wanted to have a normal delivery, and 31.4% because they wanted first to see their baby. The overwhelming majority of the participants (94.1%) experienced nervousness before the administration of epidural analgesia. It was determined that epidural analgesia extended the time of labor and increased oxygen and oxytocin requirement but did not increase the risk for interventional delivery and cesarean. To give better obstetric care and control of labor pain, it is of clinical importance to know obstetric anesthesia and analgesics.

Combined spinal-epidural analgesia vs. intermittent bolus epidural analgesia for pain relief after major abdominal surgery. A prospective, randomised, double-blind clinical trial

The primary aim of this study was to compare the efficacy of combined spinal-epidural (CSE) analgesia vs. intermittent bolus epidural analgesia (EA) for pain relief after major abdominal surgery. The secondary aim was to assess the effects of fentanyl addition to subarachnoid morphine and bupivacaine. This was a prospective, randomised, double-blind trial; 160 patients scheduled for major abdominal surgery enrolled. All patients had a thoracic epidural catheter for administration of intra-operative and postoperative analgesia. Patients were assigned to one of four groups: (i) subarachnoid morphine, bupivacaine and fentanyl (MBF group); (ii) morphine and bupivacaine (MB group); (iii) morphine (M group) and (iv) normal saline (EA group). Use of additional intravenous (i.v.) fentanyl and epidural bupivacaine was recorded to measure the need for supplemental intra-operative analgesia. Pain at rest, with movement, and with cough (measured with a visual analogue scale), additional analgesia requests, and side effects were recorded over 72 h postoperatively. Compared with the EA group, the MBF group had significantly reduced pain with cough and lower analgesia requirements during the first 24 h (p<0.001) and after EA discontinuation (p=0.041). The MBF group required less intra-operative epidural bupivacaine compared with all other groups (p<0.001), and less intra-operative i.v. fentanyl compared with group M (p<0.001). Combined spinal-epidural improved intra-operative analgesia and reduced pain with cough in the immediate postoperative period. The addition of fentanyl to subarachnoid morphine and bupivacaine decreased the need for additional i.v. fentanyl and epidural bupivacaine analgesia.