Epidural Group Research Articles

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes.

To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 ± 33.75 vs 47.39 ± 28.36 min，P = 0.001) and longer total duration of labor (790.32 ± 433.71 vs 461.33 ± 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.

Population pharmacokinetics of oxycodone in plasma and cerebrospinal fluid after epidural and intravenous administration

ABSTRACTObjectives: To establish the first plasma and cerebrospinal fluid (CSF) oxycodone population pharmacokinetic (PopPK) model after epidural (EPI) and intravenous (IV) oxycodone administration.Methods: The study was conducted with 30 female subjects undergoing elective gynecological surgery with epidural analgesia. A parallel single dose of EPI oxycodone with IV placebo (EPI group; n = 18) or IV oxycodone with EPI placebo (IV group; n = 12) was administered. An epidural catheter for drug administration was placed at T12/L1 and a spinal catheter for CSF sampling at L3/4. Plasma and CSF for oxycodone analysis were frequently collected. A PopPK model was built using the NONMEM software package.Results: Plasma and CSF oxycodone concentrations were evaluated using separate central plasma and CSF compartments and separate peripheral plasma and CSF compartments. Epidural space served as a depot compartment with transfer to both the plasma and CSF central compartments. The population parameters for plasma clearance and apparent distribution volumes for central and peripheral compartments for plasma and CSF were 37.4 L/h, 90.2 L, 68.9 L, 0.035 L (fixed based on literature), and 0.039 L, respectively.Conclusion: A PopPK model was developed and found to precisely and accurately describe oxycodone time-concentration data in plasma and CSF.

Anesthesia for Open Radical Retropubic Prostatectomy: A Comparison between Combined Spinal Epidural Anesthesia and Combined General Epidural Anesthesia.

Background Several anesthesiologic regimens can be used for open radical retropubic prostatectomy. The aim of this retrospective analysis was to compare the combined general epidural anesthesia and the combined spinal epidural anesthesia with regard to availability, efficacy, side effects, and perioperative time consumption in a high-volume center. Methods A retrospective analysis was performed by querying the electronic medical records of 1207 consecutive patients from the database of our online documentation software. All patients underwent open radical retropubic prostatectomy from 01/2008 to 08/2011 and met the study criteria. Linear and multivariate regression analyses were performed to identify differences in parameters such as time consumption in the operating unit, hemodynamic parameters, volume replacement, and catecholamine therapy. Results 698 (57.8%) patients have been undergoing open radical retropubic prostatectomy under combined spinal epidural anesthesia and 509 (42.2%) patients by combined general epidural anesthesia. Operating unit (p <0.0001) and post-anesthesia care unit stay (p <0.0001) as well as total hospital stay (p <0.0001) were significantly shorter in the combined spinal epidural anesthesia group. In addition, this group had reduced intraoperative volume need (p <0.0001) as well as lower need of catecholamines (p <0.0001). Conclusions This retrospective study suggests that the combined spinal epidural anesthesia seems to be a suitable and efficient anesthesia technique for patients undergoing open radical retropubic prostatectomy. This specific approach reduces time in the operation unit and length of hospital stay.

The relationship between pain at IUD insertion and negative perceptions, anxiety and previous mode of delivery

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women. Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15 min after the procedure) were assessed using a visual analogue scale. Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p < .001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p < .001). Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.

&lt;p&gt;Comparative effectiveness analysis of two regional analgesia techniques for the pain management of isolated multiple rib fractures&lt;/p&gt;

Background: Catheter-based regional analgesia has been proposed as an alternative to systemic analgesia for patients with multiple rib fractures (MRF). This study sought to compare the efficacy of regional techniques for decreasing pain and improving clinical outcomes.Study design: This was a multi-institutional, retrospective cohort study of adult (≥18 years) patients admitted to four nonacademic trauma centers over two years (from 07/1/2014 to 06/30/2016). Study inclusion was MRF (≥3 fractures) with no other severe injuries. Two primary regional analgesia techniques were utilized and compared: continuous intercostal nerve blocks (CINB) and epidural (EPI) analgesia. The primary outcome, average pain scores on treatment, was examined using a repeated measures, linear regression mixed model. Secondary outcomes included hospital LOS, ICU LOS, ICU admission and hospital readmission, pulmonary complications, and incentive spirometry volumes during treatment, and were examined with univariate statistics.Results: There were 339 patients with isolated MRF; 85 (25%) required regional analgesia (CINB, n=41; EPI, n=44) and the remaining 75% received systemic analgesia only (IV, n=195; PO, n=59). There were demographic and clinical differences between regional analgesia and systemic analgesia groups; on the contrary, there were no demographic or clinical differences between the CINB and EPI groups. Adjusted pain scores were similar for the EPI and CINB groups (4.0 vs 4.4, p=0.49). Secondary outcomes were worse in the EPI group compared to the CINB group: less improvement in incentive spirometry volume (p=0.004), longer ICU LOS (p=0.03), longer hospital LOS (p<0.001), and more ICU admission (p<0.001).Conclusion: In patients requiring regional analgesia, pain management was equivalent with CINB and EPI, but CINB was associated with significantly better clinical outcomes. CINB might offer an efficient alternative for pain control in patients with MRF.

Perioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial.

Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural. As a secondary outcome, all delirium assessments were then longitudinally analyzed in relation to epidural use throughout the follow-up period. Given the potential relevance to delirium, postoperative pain, opioid consumption, sleep disturbances, and symptoms of depression were also analyzed as secondary outcomes. A semiparsimonious multivariable logistic regression model was used to test the association between postoperative epidural use and delirium incidence, and generalized estimating equations were used to test associations with secondary outcomes described. Models included relevant covariates to adjust for confounding. In total, 263 patients were included for analysis. Epidural use was not independently associated with reduced delirium incidence (adjusted odds ratio, 0.65 [95% CI, 0.32-1.35]; P = .247). However, when analyzing all assessments over the follow-up period, epidural patients were 64% less likely to experience an episode of delirium (adjusted odds ratio, 0.36 [95% CI, 0.17-0.78]; P = .009). Adjusted pain scores (visual analog scale, 0-100 mm) were significantly lower in the epidural group on postoperative day 1 (morning, -16 [95% CI, -26 to -7], P < .001; afternoon, -15 [95% CI, -25 to -5], P < .01) and postoperative day 3 (morning, -13 [95% CI, -20 to -5], P < .01). Adjusted mean oral and IV morphine equivalents were also significantly lower on postoperative day 1 in the epidural group (74% lower [95% CI, 55%-85%]; P < .0001). Finally, postoperative epidural use was not significantly associated with new sleep disturbances or changes in depression symptoms. Postoperative epidural use was not associated with a reduced overall incidence of delirium. However, longitudinal analysis revealed reduced adjusted odds of experiencing an episode of delirium in the epidural group. Epidural use was also associated with reduced postoperative pain and opioid consumption. An appropriately designed follow-up study is warranted to further analyze the relationship among epidural use, postoperative delirium, and related outcomes.

Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study

ObjectivesPrevious studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia...

Comparison of IL-6 and CRP Concentration Between Quadratus Lumborum and Epidural Blockade Among Living Kidney Donors: A Randomized Controlled Trial

BackgroundAn adequate anesthesia technique generates appropriate postoperative analgesic properties and decreases the patient’s stress response. This will lead to decreased morbidity and mortality associated with immunology disturbances, such as infection, prolonged wound healing, and sepsis.ObjectivesThe aim of this study was to compare interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, as the markers of the stress response, between continuous epidural and quadratus lumborum (QL) block as postoperative analgesia techniques among living kidney donors.MethodsSixty-two patients were randomly divided into two equal groups: continuous epidural and QL block. A group received bilateral QL block with 20 mL of bupivacaine 0.25% and the other received 6 mL/hour of bupivacaine 0.25% continuously via an epidural catheter. Prior to extubation, the QL block group received bilateral QL block with the same dose and the continuous epidural group was administered with 6 mL/hour of bupivacaine 0.125%. Blood samples were drawn to compare IL-6 and CRP concentrations after intubation (preoperatively), directly after surgery, 24 hours postoperatively, and 48 hours postoperatively. Postoperative pain was measured with the numerical rating scale (NRS). Morphine requirement and duration of catheter usage were also measured postoperatively. Side effects within 24 hours postoperatively were noted. Data were analyzed with independent t-test or Mann-Whitney test.ResultsNo difference was observed between the groups in the plasma concentration of IL-6 either after surgery or 24 hours postoperatively (P = 0.785 and P = 0.361, respectively) although the mean IL-6 concentration 24 hours postoperatively was lower in the QL block group than in the continuous epidural group. CRP concentration was not significantly different between the groups either after surgery or 48 hours postoperatively (P = 0.805 and P = 0.636, respectively).ConclusionsThere was no significant difference in IL-6 and CRP concentrations between continuous epidural and QL block among living kidney donors. Both continuous epidural and QL block techniques showed comparable postoperative analgesic properties among living kidney donors undergoing laparoscopic nephrectomy.

Epidural Analgesia in Open Thoraco-Abdominal Aortic Aneurysm Repair

Epidural analgesia improves pain control and outcomes of abdominal aortic aneurysm procedures, while the effect of thoracic epidural analgesia on thoraco-abdominal aortic aneurysm (TAAA) repair is unknown. The aim of the study was to evaluate thoracic epidural analgesia effects in patients undergoing open TAAA repair in terms of pain control and clinically relevant outcomes. This was a retrospective study of a prospectively collected database. Patients undergoing open TAAA repair between January 2009 and December 2016. Four hundred and fifty-nine consecutive patients were included. Thoracic epidural analgesia was used in 409 (89%) of cases. On multivariable analysis, patients who received thoracic epidural analgesia experienced reduced post-operative pain (odds ratio [OR] 0.003, 95% confidence interval [CI] 0.0007–0.009; p < .001), a lower rate of acute kidney injury (AKI; OR 0.39, 95% CI 0.21–0.71 [p = .002]), atrial fibrillation (OR 0.47, 95% CI 0.23–0.95; p = .04), acute myocardial infarction (AMI; OR 0.189, 95% CI 0.05–0.64; p = .008), and paraplegia (OR 0.31, 95% CI 0.157–0.615; p = .001) compared with the conventional analgesia (CA) group. After propensity score matching, 43 patients in the CA group were compared with 43 in thoracic epidural analgesia group. On case match analysis thoracic epidural analgesia showed a significant reduction in post-operative pain (p < .001) and no differences in the incidence of AKI, atrial fibrillation, AMI, and paraplegia. In the thoracic epidural analgesia group there were no epidural haematomas. Thoracic epidural analgesia was effective in reducing post-operative pain with no effect on major post-operative complications. The use of thoracic epidural analgesia, if not contraindicated, might be considered in clinical practice, even in patients undergoing Open TAAA repair. Whether a better post-operative management enhances patient's recovery in this setting remains to be tested.

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period

Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6(IL-6), interleukin-8(IL-8) levels in elderly patients with lung cancer during perioperative period. Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods, they were divided into inhalation anesthesia group(A group), general intravenous anesthesia group(B group) and epidural block anesthesia group(C group), with 30 cases in each group.The minimum mental state examination(MMSE) scores, cognitive dysfunction rate, serum IL-6 and IL-8 levels of the three groups before operation, one day after operation and three days after operation were compared. Results One day and three days after operation, the MMSE scores of C group were (25.62±2.11)points, (27.12±2.04)points, respectively, which were higher than those of group A[(22.61±2.75)points, (25.78±2.68)points] and B group[(22.34±2.01)points, (25.81±2.42)points], the differences were statistically significant(tA group=4.756, 2.179, tB group=6.165, 2.267, all P<0.05). One day and three days after operation, the cognitive dysfunction rates of C group were 26.67%(8/30), 6.67%(2/30), respectively, which were lower than those of A group[50.00%(15/30), 26.67%(8/30)] and B group[66.67%(20/30), 30.00%(9/30)], the differences were statistically significant(χA group2=3.455, 4.320, χB group2=9.643, 5.455, all P<0.05). One day and three days after operation, the serum IL-6 and IL-8 levels of C group[IL-6: (99.53±16.82)ng/mL, (83.24±8.34)ng/mL, IL-8: (50.43±7.84)ng/mL, (42.15±5.25)ng/mL] were lower than those of A group[IL-6: (122.43±18.41)ng/mL, (88.51±10.42)ng/mL, IL-8: (64.53±8.94)ng/mL, (55.62±6.78)ng/mL]and B group[IL-6: (124.52±20.10)ng/mL, (87.95±9.34)ng/mL, IL-8: (63.27±9.03)ng/mL, (54.62±6.30)ng/mL], the differences were statistically significant(IL-6: tA group=5.030, 2.163, tB group=5.222, 2.060, all P<0.05; IL-8: tA group=6.495, 8.604, tB group=5.881, 8.329, all P<0.05). Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal, which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods, and it is worthy of radical operation for elderly patients with lung cancer. Key words: Lung neoplasms; Aged; Anesthesia, Inhalation; Anesthesia, General; Anesthesia, Epidural; Cognitive function; Inflammatory factors

Does fentanyl epidural analgesia affect breastfeeding: A prospective cohort study.

Concerns have been expressed in relation to a possible negative effect of fentanyl epidural analgesia on breastfeeding rates. A 2016 systematic review was inconclusive and suggested cohort studies be performed with control groups to allow for other potential confounding factors. To assess the effect of fentanyl epidural analgesia in labour on breastfeeding practices. A prospective cohort study, conducted at a metropolitan hospital, Ipswich, Queensland. Eligible women were first-time mothers, wishing to breastfeed after a vaginal birth at term. Women who had fentanyl epidural only (107) were compared with women who had subcutaneous morphine only (90), and women who had neither subcutaneous morphine nor epidural (107). Fewer women in the fentanyl epidural analgesia group were fully breastfeeding when leaving hospital (54.2% compared to 69.2% in the no analgesia group and 77.8% in the subcutaneous morphine group; P<0.05). At 6weeks postpartum, there was no evidence of difference between the groups (43% for fentanyl epidural analgesia, 52.3% for no analgesia group and 48.9% for subcutaneous morphine group; P=0.63). Rates of induction of labour, instrumental birth and admission to special care nursery differed significantly between groups and when controlled for these, there was no association between fentanyl epidural analgesia and breastfeeding at discharge (adjusted odds ratio (OR) 0.74; 95% CI 0.39-1.41) or at 6weeks postpartum (OR 0.75; 95% CI 0.41-1.38). Our study did not find an association between fentanyl epidural analgesia in labour and rates of fully breastfeeding at discharge and at 6weeks postpartum.

Comparison between the effect of epidural anesthesia combined with epidural analgesia and general anesthesia combined with intravenous analgesia on prognosis of ovarian cancer patients

Application value of epidural anesthesia combined with epidural analgesia and general anesthesia combined with intravenous analgesia in ovarian cancer surgery was explored. In total 298 ASA I–III grade patients with ovarian cancer, undergoing extensive total hysterectomy and pelvic lymphotomy, were retrospectively analyzed. Patients were divided into two groups: the epidural anesthesia combined with epidural analgesia group (group A, 158 cases), and the general anesthesia combined with intravenous analgesia group (group B, 140 cases). The first exhaust time, incidence of adverse reactions, Aldrete score, and recovery were observed, and the visual analogue scale (VAS) scores during resting, exercise and cough at 24 h after surgery were recorded. Fasting venous blood (2 ml) was drawn at the same time before anesthesia and at 24 h after anesthesia in both groups to determinate cortisol (COR) and C-reactive protein (CRP) levels. The first exhaust time and incidence of adverse reactions in group A were significantly lower than those in group B (P<0.05). The Aldrete score and extubation time (ET) in group A were significantly higher than that in group B. Eye opening time (EOT), recovery orientation time (ROT) and post-anesthesia care unit (PACU) time in group A were significantly lower than those in group B (P<0.05). The VAS scores in group A during resting, exercise and cough were lower than those in group B (P<0.05). Compared with before anesthesia, the levels of COR and CRP increased significantly in both groups at 24 h after anesthesia (P<0.05), while the level of COR and CRP in group A was significantly lower than that in group B, at 24 h after surgery (P<0.05). Epidural anesthesia combined with epidural analgesia has better analgesic effect, higher safety, lower incidence of adverse reactions, and is beneficial to the recovery of patients with ovarian cancer after radical operation when compared with general anesthesia combined with intravenous analgesia.

Effect of two types of anesthesia on postoperative recovery of patients with gastric cancer and changes in the levels of their T lymphocyte subsets

Purpose: To investigate the effects of two types of anesthesia on postoperative recovery of patients with gastric cancer (GC), and to assess changes in the levels of their T lymphocyte subsets.Methods: Patients with GC (200 cases) were randomly assigned to two groups of 100 patients each: general anesthesia (GA) group and GA + epidural anesthesia (GAEP) group. Fasting venous blood samples (2 mL) were collected from the patients before anesthesia, and at different time-points: zero time (T0), 1 h (T1), day 1 (T2), and day 3 (T3) after surgery. CD3+, CD4+, CD8+T, and regulatory T cells (Tregs) were determined using a flow cytometer.Results: Percent CD3+, CD4+, CD8+T, and ratio of CD4+ to CD8+ in both groups at 1 h and day 1 after operation were significantly lower than their values before anesthesia (p &lt; 0.05). There were significant differences in CD3+ and CD4+ levels between the two groups on day 3 (p &lt; 0.05). Percent peripheral CD4+ CD25+T, and ratio of CD4+ CD25+ to CD4+ in both groups also significantly increased at 1 h and day 1 after operation, while percent peripheral CD4+, CD25+T and CD4+ CD25+ to CD4+ ratio in GAEP group on day 1 after operation were significantly lower than those of GA group (p &lt; 0.05).Conclusion: These results suggest that combination of general and epidural anesthesia partly controls the expressions of Tregs, thereby enhancing postoperative recovery of GC patients.Keywords: Gastric cancer, T-lymphocyte subsets, Regulatory T-lymphocytes, Epidural, Anesthesia

Patients’ perspective of quality-of-life issues in a randomized study in open surgery of patients with renal cell carcinoma.

642 Background: This randomized study in patients treated with open surgery for renal cell carcinoma (RCC), aimed to evaluate if effective perioperative analgesia can be part of a multimodal approach to minimize morbidity and improve postoperative management [1]. To evaluate the patients’ perspectives, a survey was used before surgery and one month after surgery. Methods: Between 2012 and 2015, 135 patients with RCC, in all stages, were randomized to receive either spinal analgesia with added clonidine, or epidural analgesia in addition to general anesthesia: The patients were stratified according to surgical technique. Inclusion criteria: ASA score ≤ III, age &gt; 18 years, and no chronic pain medication or cognitive disorders. The patient’s survey used was based on the EORTC QLQ-C30 formula. Wilcoxon Signed Rank test and Mann-Whitney-U tests were used for statistical evaluation. Results: Most patients (117 of 135, 86 %) responded to the survey postoperatively. Patients groups treated with partial nephrectomy or radical nephrectomy both had significantly reduced physical and social functioning while emotional functioning improved postoperatively. In both surgical groups the patients reported significant negative financial difficulties. Similar results was achieved for patients treated with either spinal or epidural anesthesia. The epidural group of patients experienced more negative social functioning but had an improved global health. When comparing the surgical procedures there was no significant difference in the quality of life parameters. However when comparing the analgesic groups, spinal anesthesia had significantly better physical and social functioning while the patients in the epidural group reported better global health. Conclusions: In this randomized controlled study on nephrectomy, patients treated with spinal analgesia with clonidine, had better physical and social functioning postoperatively than patients treated with epidural analgesia. Clinical trial information: NCT02030717.

How effective is periarticular drug infiltration in providing pain relief following Total Knee Replacement as compared to epidural analgesia?

IntroductionThe aim of the study was to compare the efficacy of pericapsular injection of analgesic drugs (PAI) with epidural analgesia (EA), in providing post-operative pain relief and early functional improvement of following Total Knee Arthroplasty. Materials and methods50 patients were randomized to 2 arms of 25 patients each, receiving either pericapsular injection or epidural analgesia. The Visual Analogue Scale (VAS), functional outcomes and side effects related to the EA and PAI groups were assessed. ResultsThe PAI group had significantly better pain relief on the first post-operative day with a mean VAS on 3.6 as opposed to 7 in the epidural group(p = 0.006). Functional outcomes in the PAI group were significantly better in the early post-operative period with patients taking less time to achieve the same physiotherapy goals – straight leg raising, climb 14 steps and walking 50 m. Side effects like nausea, vomiting, pruritus and urinary retention were less with PAI. However, by the 5th postoperative day, functional independence and pain control were similar in both groups. ConclusionPericapsular injection of analgesic drugs in total knee arthroplasty provides better pain control and functional recovery than epidural analgesia in the early post-operative period, and can be the choice method for analgesia following total knee replacement.

Using quantile regression to re-evaluate the epidural labor analgesia under new partogram: a prospective cohort study

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression. Methods In this study, we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology, Tongji Medical College, Huazhong University of Science and Technology from May to September, 2018. The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150), and those who were not to the control group (n=150). Labor duration and delivery outcomes were analyzed by Student's t test, Mann-Whitney U test, Chi-square test and Fisher's exact test. Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration. Results The median durations of first- and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min, respectively, which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273, P 0.05). Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor, especially with the first stage of labor, but has no adverse effects on maternal and neonatal outcomes. Key words: Labor, obstetric; Anesthesia, epidural; Labor stage, first; Labor stage, second; Regression analysis; Prospective studies

Effect of anesthesia factor on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension

Objective To compare the effects of general anesthesia and spinal anesthesia on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension (PAH). Methods Parturients with medium and severe PAH, at ≥24 weeks of gestation, aged 20-45 yr, undergoing elective cesarean section under general or epidural anesthesia from November 1, 2011 to December 31, 2017 in our hospital, were divided into general anesthesia group and epidural anesthesia group according to the anesthetic method. General anesthesia was combined intravenous-inhalational anesthesia. The highest temperature within 5 days after surgery, the lowest SpO2 (inhaling oxygen 2-4 L/min via a nasal tube) within 3 days after surgery, duration of intensive care unit stay, time of postoperative use of antibiotics, requirement for targeted drugs for pulmonary hypertension, results of laboratory tests (blood biochemistry, coagulation function), postoperative mechanical ventilation, length of hospital stay, and hospitalization costs were recorded. The Apgar score and weight of the newborn, postoperative complications and death of the newborn and parturients in hospital were recorded. Cox regression analysis was used to identify the risk factors after cesarean section in parturients with medium and severe PAH. Results Fifty-seven parturients were enrolled in this study, with 21 cases in general anesthesia group and 36 cases in epidural anesthesia group. Compared with general anesthesia group, the rate of postoperative mechanical ventilation was significantly decreased, the incidence of adverse events of parturients in hospital and mortality rate were decreased, the postoperative level of albumin was increased, activated partial thromboplastin time was shortened (P 0.05). The results of Cox regression analysis showed that anesthetic method and preoperative SpO2 difference were independent risk factors for cesarean section-related adverse events and death of parturients with medium and severe PAH. The risk of adverse events and death of parturients was significantly higher in general anesthesia group than in epidural anesthesia group (P<0.05). Conclusion Epidural anesthesia produces better prognosis than general anesthesia when used for cesarean section in parturients with moderate and severe PAH. Key words: Hypertension, pulmonary; Anesthesia; Cesarean section; Prognosis

Community Hospital Experience of Surgical times and Outcomes in Patients Undergoing Cesarean Deliveries for Non-Reassuring Fetal Tracing: A Retrospective Cohort

Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min); 2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly shorter in the GA group when compared to spinal and epidural groups, P < 0.001. The estimated blood loss (EBL) was similar between these three groups. Both arterial and venous umbilical cord mean PH were comparable in GA, spinal and epidural groups. Potential complications of GA include 36% of newborns had an Apgar score of less than 7 at 1 minute in GA group when compared to 15% of newborns in the epidural group, and 22% of newborns in the spinal group, which was not statistically significant. When comparing the NICU admission between the groups: 77% of newborns delivered under GA required NICU admission, 54% of the newborns delivered via epidural anesthesia were admitted versus 50% of newborns delivered via spinal anesthesia. Conclusion: The induction of general anesthesia for emergency cesarean section resulted in shorter times to delivery compared to spinal and epidural. General anesthesia was associated with lower, albeit not statistically significant Apgar scores and higher NICU admissions, and had similar cord gases compared to neuraxial anesthesia group.

Retrospective analysis of regional anesthesia techniques employed for postoperative pain management in pediatric patients undergoing pyeloplasty

Context: Pediatric pain management is always a challenge for the anesthesiologist as surgery and pain inflicted at a young age has a bearing on the response to pain in the future. Aims: The aim of the study was to compare the different regional anesthesia techniques adopted for the postoperative pain relief in children aged between 6 months and 6 years who underwent open pyeloplasty. Settings and Design: It was a retrospective study. Materials and Methods: Children were divided into three groups: caudal group (n = 18), epidural group (n = 23), and transversus abdominis plane (TAP) group (n = 32) based on the regional anesthesia technique used. The primary outcome measured was total duration of postoperative analgesia. The secondary outcomes measured were median Face, Legs, Activity, Cry, Consolability (FLACC) score, intraoperative and postoperative heart rate, and mean arterial pressure along with incidence of any complication. Statistical Analysis Used: One-way ANOVA and Kruskal–Wallis test were applied for comparison between the three groups. Results: Postoperative analgesia duration in minutes was highest in the epidural group (1117.3 ± 112.2), followed by TAP group (1070.0 ± 109.3) and caudal group (261.5 ± 18.2). Median FLACC pain scores achieved at 12 and 24 h were least in the epidural group, followed by the TAP and caudal groups. Conclusions: Epidural analgesia is best suited in terms of the duration as well as the quality of postoperative analgesia is concerned, but surgeon-assisted TAP block looks promising and a feasible option with comparable postoperative analgesia quality and duration.

Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women.

Introduction:The labor pain is probably the most severe pain a mother experiences in her lifetime and is usually severe and prolonged in women with pregnancy,Aim:To evaluate the effects of labor epidural and spinal analgesia on the incidence of cesarean section in painless delivery.Methods:This randomized clinical trial was conducted on pregnant women aged 37-42 weeks of pregnancy. Female candidates for painless labor were divided into two groups: Epidural Analgesia (EA) and Spinal Analgesia (SA). Patients in the labor epidural group underwent analgesia using marcaine and fentanyl and after fully assuring the normal hemodynamic status of the mother and fetal hearth rate (FHR), labor spinal analgesia was used for other group.Results:The average age of mothers was 27.5 years, their mean gestational age was 39 weeks and their mean weight was determined to be 72 kg. Frequency of cesarean delivery in mothers was found as 12.9%. Significantly, the incidence of cesarean section in the labor epidural analgesia group was higher than the labor spinal analgesia group (P = 0.02). In addition, the mean second phase of delivery in the labor epidural analgesia group was significantly higher than the labor spinal analgesia group (P = 0.03). There was no significant in 1st and 5th min Apgar scores between groups in infants (8.6 and 9.6, respectively).Conclusion:Labor epidural analgesia and labor spinal analgesia result in a significant reduction in pain due to normal delivery. Due to the similarity of Apgar and arterial blood gas (ABG) in neonates, labor epidural analgesia may serve as an alternative in childbirth delivery.