Pain In Parturients Research Articles

A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine

(Anesth Analg. 2022;135:912–925) Opioid use disorder (OUD) has been on the rise over the past decade and is the leading cause of mortality among pregnant women in the United States. Information and evidence-based recommendations on how to best treat pain in parturients with OUD is lacking. The aim of this scoping review was to highlight existing literature on peripartum pain management for women with OUD, both untreated and treated with medications for opioid use disorder (MOUD), and provide a summary of the information.

Comparative study of the efficacy of dexmedetomidine and fentanyl on anxiety and pain of parturients with different COMTva1158met genotypes

ObjectiveThis study investigates the effects of COMTval158met gene polymorphism on maternal anxiety and pain during delivery and on the analgesic and anxiety efficacy of dexmedetomidine during delivery.MethodsSixty-one pregnant women, who were hospitalized in our hospital from January to November of 2016 were recruited and randomly divided into two groups, F and D groups. The pregnant women in the F group were given labor analgesia with ropivacaine combined with fentanyl. The pregnant women in the D group were given labor analgesia with ropivacaine combined with dexmedetomidine. Before and after labor analgesia, the genotype of COMT in the blood from two groups was detected, and the situation of labor anxiety and analgesia was analyzed. Then, the relationship between labor anxiety, analgesia, and COMT polymorphism was analyzed.ResultsIn the 61 pregnant women, there were 30 women of wild homozygotes (GG) of COMT, 22 women of mutant heterozygotes (GA), and nine women of mutant homozygotes (AA), the mutation rate of allele A was 23.77%. The anxiety status score, anxiety trait score, and pain score in the AA genotype were significantly higher than those in the GG and GA genotype (p < 0.05). There was a significant difference in the efficacy of GG and AA genotypes between groups D and F for treating labor anxiety (p < 0.05), the efficacy of group D was better than that of group F in treating delivery anxiety, there was no significant difference in anxiety scores between the two groups in GA genotypes (p > 0.05); there was no significant difference in pain between group D and F in GG, GA, and AA genotypes (p > 0.05). There was no significant difference in pain and anxiety scores between the three genotypes in group D (p > 0.05), there was significant difference in pain scores among the three genotypes in group F (p < 0.05), but there was no significant difference in anxiety (p > 0.05).ConclusionsThe mutation of the COMTval158met gene leads to increased anxiety and pain during childbirth. The effect of dexmedetomidine on the anxiety of GG and AA genotypes is better than that of fentanyl, and the mutation of the COMTval158met gene has no impact on dexmedetomidine effect.

Electroencephalogram-derived pain index for evaluating pain during labor.

BackgroundThe discriminative ability of a point-of-care electroencephalogram (EEG)-derived pain index (Pi) for objectively assessing pain has been validated in chronic pain patients. The current study aimed to determine its feasibility in assessing labor pain in an obstetric setting.MethodsParturients were enrolled from the delivery room at the department of obstetrics in a tertiary hospital between February and June of 2018. Pi values and relevant numerical rating scale (NRS) scores were collected at different stages of labor in the presence or absence of epidural analgesia. The correlation between Pi values and NRS scores was analyzed using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to estimate the discriminative capability of Pi to detect labor pain in parturients.ResultsEighty paturients were eligible for inclusion. The Pearson correlation analysis exhibited a positive correlation between Pi values and NRS scores in parturients (r = 0.768, P < 0.001). The ROC analysis revealed a cut-off Pi value of 18.37 to discriminate between mild and moderate-to-severe labor pain in parturients. Further analysis indicated that Pi values had the best diagnostic accuracy reflected by the highest area under the curve (AUC) of 0.857, with a sensitivity and specificity of 0.767 and 0.833, respectively, and a Youden index of 0.6. Subgroup analyses further substantiated the correlations between Pi values and NRS scores, especially in parturients with higher pain intensity.ConclusionThis study indicates that Pi values derived from EEGs significantly correlate with the NRS scores, and can serve as a way to quantitatively and objectively evaluate labor pain in parturients.

Analgesic Effects of Epidural Labor Analgesia at Different Periods and Its Effects on Maternal and Infant Outcomes and MiRNA-146b Level.

This paper aimed to analyze the analgesic effects of continuous epidural labor analgesia (ELA) at different periods and its effects on postpartum depression, maternal and infant outcomes, and maternal blood pressure. Giving birth in our hospital from September 2017 to August 2019, 119 primiparas with spontaneous delivery were enrolled and divided into an observation group (65 cases) and a control group (54 cases). Patients in the observation group received epidural block analgesia in advance, whereas those in the control group received epidural block analgesia routinely. At 25 days after delivery, breast milk samples were collected, in which miRNA-146b level was detected by PCR. The patients were compared between the two groups with respect to progress of labor, analgesic effects during 3 stages of labor, labor outcomes, adverse reactions, and levels of NO, ANP, and ET-1 in the parturients' umbilical artery blood. Compared with those in the control group, patients in the observation group had a remarkably higher miRNA-146b level in the breast milk (P < 0.05), remarkably lower average Visual Analogue Scale (VAS) scores during the active phase and the second stage of labor (P < 0.05), and remarkably higher levels of NO, ANP, and ET-1 (P < 0.05). There were no statistically significant differences in adverse reactions and modes of delivery between the two groups (P < 0.05). ELA starting from the latent phase can improve the miRNA-146b level in maternal breast milk, alleviate labor pain of parturients, and shorten stages of labor. Therefore, our study is worthy of clinical promotion. We still need to do more experiments and use more data to conclude more scientific results in future research work.

The Effect of Different Surgical Approaches of Ultrasound-Guided Quadratus Lumborum Block on the Analgesic Effect in Cesarean Section

Objective To study the effect of different surgical approaches of ultrasound-guided quadratus lumborum block on the analgesic effect in cesarean section. Methods 150 parturients underwent elective caesarean section in our hospital from February 2017 to February 2020 were enrolled in this study. They were divided into observation group and control group according to the method of random number table, with 75 cases in each group. In control group, anterior QLB was used, while in observation group, posterior QLB was used. The operation process was performed by the same anesthesiologist. If the injection situation was not ideal, the position of needle tip was timely adjusted. Both groups were given sufentanil 100 HQ/kg (diluted with 100 mL normal saline) and a single addition of morphine 50 mg (diluted with 100 mL normal saline) for self-controlled analgesia after operation. The postoperative time to first water intake, the time to first discharge from bed, hospital stay and satisfaction degree of labor pain were compared between the two groups. The numerical pain score (NRS) and visual analogue scale (VAS) scores of rest and movement at different time after operation were compared. The dosage of sufentanil and morphine in perioperative period and the occurrence of postoperative adverse reactions were compared between the two groups. Results The time to first water intake, the time to first discharge from bed and hospital stay in the observation group were significantly shorter than those in the control group (P &lt; 0.05), and the satisfaction score of analgesia in the observation group was significantly higher than that in the control group (P &lt; 0.05). The NRS score of observation group at TO, 1, 2, 3 and 4 after operation was significantly lower than that of control group (P &lt; 0.05). There was no significant difference in VAS score of rest and movement at 4 and 8 h after operation between the two groups (P &gt; 0.05); the VAS score of rest and movement at 12 and 24 h after operation in observation group was significantly lower than that in control group (P &lt; 0.05). The amount of sufentanil and morphine used in the perioperative period in the observation group was significantly less than that in the control group (P &lt; 0.05). The total incidence rate of adverse reactions in observation group was not significantly different from that in control group (P &gt; 0.05). Conclusion Both anterior and posterior QLB can provide analgesia after cesarean section, but posterior QLB can better relieve the postoperative pain of parturients, which is worth popularizing in clinic.

Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception.

BackgroundIntraoperative pain is a possible complication of neuraxial anaesthesia for caesarean delivery. There is little information available about its incidence, risk factors and physician perception.MethodsParturients undergoing spinal anaesthesia for elective caesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postoperative pain levels, Spielberger STATE‐TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anaesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden's R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen's kappa and 95% Confidence Intervals (CI).ResultsWe included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0 (1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictor of intraoperative pain (p‐value of β‐coefficient = 0.43, Mc Fadden's R2 = 0.01). Including further preoperative variables did not result in a good prediction model. Cohen's kappa between reported pain by parturient and by the obstetrician was 0.21 (95% CI: 0.01, 0.41) and by the anaesthesiologist was 0.3 (95% CI: 0.12, 0.48).ConclusionsWe found a substantial incidence (11.9%) of intraoperative pain during caesarean delivery. Preoperative anxiety did not predict intraoperative pain. Physicians did not accurately identify parturients’ intraoperative pain.SignificanceIntraoperative pain occurred in 11.9% and severe intraoperative pain occurred in 1.11% of parturients undergoing elective caesarean delivery under spinal anaesthesia. We did not find any preoperative variables that could reliably predict intraoperative pain. Obstetricians and anaesthesiologists underestimated the incidence of intraoperative pain in our cohort and thus, more attention must be put to parturients’ pain.

Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study.

We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor. Chronic headache, backache, and disability were assessed 18-24months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher's exact test to calculate odds ratios. There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache. In the PDPH-no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group. Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP-treated patients.

STUDY ON THE HEALTH AND SELF-EFFICACY OF PREGNANT WOMEN IN DELIVERY WITH MUSIC ANALGESIA AND LABOR DOULA

ABSTRACT To explore the effect of delivery supported by a labor doula combined with music therapy on stabilizing maternal psychology and improving delivery quality, and to find out the predictors of delivery self-efficacy. Statistical processing showed that P&lt;0.05, which was statistically significant. Group was superior in numerical value, followed by the B group. Using the rank sum test, the pain grade of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P&lt;0.05). T test or χ2 test showed that the total labor time of the experimental group was shorter than that of the control group. Vaginal delivery rate was higher than that of the control group, and the cesarean section rate was lower than that of the control group, and the difference was statistically significant (P&lt;0.05). Conclusion: Doula delivery combined with music therapy is effective in parturient delivery, which can alleviate parturient pain, speed up labor progress and improve delivery quality, and is worthy of popularization and application. At the same time, increasing pregnant women’s understanding of delivery strategies and techniques and improving their psychological state will help improve the level of delivery self-efficacy of pregnant women.

Tecnologias não farmacológicas e tempo de trabalho de parto e parto: revisão sistemática sem metanálise

Objetivo: identificar, na literatura, associações entre o uso de tecnologias não farmacológicas e o tempo de trabalho de parto e parto. Métodos: revisão sistemática sem metanálise, incluindo somente ensaios clínicos randomizados. Fator de exposição: terapias não farmacológicas de alívio da dor. Desfecho: tempo de trabalho de parto e parto. Resultados: nove artigos foram identificados. Três não apresentaram eficácia relacionada ao tempo de trabalho de parto e parto, contudo, um obteve para os dois períodos do trabalho de parto e parto, dois para a duração total do trabalho de parto e parto, um para o período expulsivo de forma isolada e duração total do trabalho de parto e parto e dois somente para o período expulsivo. Conclusão: as tecnologias não farmacológicas de alívio da dor, aplicadas de forma isolada ou combinada, apresentam potencial efetivo no alívio da dor de parturientes e redução significativa do tempo de trabalho de parto e parto.

Intravenous dexmedetomidine enhances the experience of visceral pain in parturients during cesarean delivery under spinal anesthesia

Background and hypothesis Visceral pain is a common incidence in cesarean delivery under spinal anesthesia. Dexmedetomidine (DEX) has analgesic, sedative, anxiolytic effect, as it is an α 2-receptor agonist. Intraoperative visceral pain resulting from manipulation of the uterus and traction of the peritoneum is still a challenge for anesthetists. The present study hypothesized that single intravenous bolus dose of DEX added as a supplement to intrathecal anesthesia for an elective cesarean section could reduce intraoperative visceral pain, lessen blood pressure swings, and produce an acceptable sedative effect, with minimal fetal and maternal consequences. Patients and methods A randomized double-blinded placebo-controlled study was conducted. A total of 70 patients were randomly allocated to receive either intravenous DEX or placebo (saline) before spinal anesthesia. The primary outcomes were decreased intraoperative visceral pain. Secondary outcomes included the stability of hemodynamic parameters (blood pressure and heart rate), sedation score, time to rescue analgesia reduction, neonatal APGAR score, and any adverse effects (nausea and vomiting). Results There was a significant difference between the groups in the incidence of moderate to severe visceral pain (P&lt;0.001), intraoperative fentanyl requirements (P=0.004), and longer time to rescue analgesia (P&lt;0.001). Both groups had comparable mean blood pressure (P&gt;0.005); however, there was a highly significant difference in heart rate (P=0.01). Moreover, a significantly higher sedation score was seen in the DEX group (2.08±0.8) in comparison with the control group (1±0). APGAR score was comparable in the studied groups. Conclusion As a single intravenous bolus, DEX seems to be an excellent supplement to intrathecal anesthesia for an elective cesarean section. It can reduce intraoperative visceral pain and lessen blood pressure swings and produce an acceptable sedative effect with minimal fetal and maternal influence.

Effects of Midwifery Care on Mode of Delivery, Duration of Labor and Postpartum Hemorrhage of Elderly Parturients.

Background:We aimed to explore the influence of midwifery care on the mode of delivery (MOD), duration of labor and postpartum hemorrhage (PPH) of elderly parturients.Methods:A total of 165 elderly parturients admitted to Tongde Hospital of Zhejiang Province, China from May 2018 to Aug 2019 were allocated into a study group (n=85, midwifery care) and a control group (n=80, conventional nursing care). Visual analogue scale (VAS) was employed to estimate the pain of parturients, and self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate the anxiety and depression status. The satisfaction of patients on nursing care was scored by a self-made satisfaction questionnaire.Results:The parturients in the study group presented higher spontaneous vaginal delivery (SVD) rate (P < 0.05), and had shortened duration of first and second stages of labor and total duration of labor (P < 0.05). The incidence of both PPH and neonatal asphyxia in the study group was lower than that in the control group (both P < 0.05). The VAS, SAS and SDS scores in the study group were significantly lower than those in the control group (P < 0.05), and the patients’ satisfaction in the study group was significantly higher (P < 0.05).Conclusion:Midwifery care is effective for the delivery of elderly parturients, which significantly improves VSD rate, shortens duration of labor, reduces incidence of PPH and neonatal asphyxia, as well as relives labor pain, anxiety and depression, and increases satisfaction of parturients.

Oral Gabapentin versus Pregabalin for Postoperative Pain Relief in Elective Cesarean Section Patients under Spinal Anesthesia

Background: Pain after Cesarean delivery is the main postoperative complain in parturients, pregabalin and gabapentin have been shown to decrease acute postoperative pain in parturient. Objective: The aim of the study was to compare gabapentin and pregabalin as oral premedication in patients for elective cesarean section under spinal anesthesia for postoperative pain relief and the need to rescue analgesia. Methods: This study was carried out at Obstetric Operating Rooms, Zagazig University Surgical Hospitals. The study included 54 consenting women aging 20–40 yrs old with uncomplicated pregnancies that were scheduled to undergo elective Cesarean section delivery under spinal anesthesia. They were randomly allocated into three equal groups. Group (P) received 300 mg pregabalin, group (G) received 900 mg gabapentin, and control group (C). The study medication given orally one hour before the anticipated time of the surgical incision, and data measured included visual analogue scale (VAS), the total doses of analgesia, the incidence of post-operative nausea and vomiting (PONV) and the level of sedation. Results: The VAS was comparatively low in patients of group P as compared to G and C groups (P value < 0.05). Total analgesic requirement of pethidine in first 24 h was significantly lower in groups P as compared to groups G & C (P value < 0.001). We found that there was statistically significant increase in the sedation scores of the patients in P group as compared to G & C groups. Conclusion: Pregabalin 300 mg was more effective than gabapentin300 mg in reducing post Cesarean section pain, opioid consumption, nausea, and vomiting.

Postpartum Infectious Sacroiliitis Temporally-Related to Continuous Labor Epidural Analgesia: Was the Epidural to Blame? A Case Report and Review of the Literature

Infectious (bacterial) sacroiliitis, though rare, yet needs to be considered at the differential diagnosis of back/leg pain in parturients. The following is a case of infectious sacroiliitis in a postpartum patient that presented four days after delivery with hip and leg pain. Interestingly, the patient's labor analgesia was conducted with a continuous lumbar epidural analgesia; however, a causal relationship remains to be determined.

The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section : Aretrospective analysis.

Intense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization. This retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C‑sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period. The institution's medical database was searched for parturients who underwent emergency C‑sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C‑sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0-10) was recorded up to 96 h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 h postoperatively. In the ELA, no-ELA, and elective groups, 61, 73, and 88parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 h postoperatively than those in the ELA group (P = 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P = 0.001) and elective groups (P < 0.001) at 6-24 h postoperatively. Moreover, the proportion of patients requiring rescue analgesics ≥2times was also significantly higher in the no-ELA group (vs. the ELA group, P = 0.004; vs. the elective group, P < 0.001). Parturients undergoing emergency C‑sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C‑sec may act as pre-emptive analgesia against postoperative pain.

Post Dural Puncture Headache, Managed with Epidural Blood Patch, Is Associated with Subsequent Chronic Low Back Pain in Patients: a Pilot Study.

Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH. The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP. A total of 146 patients were contacted and completed a survey questionnaire via telephone. The EBP group was found to be more likely to have chronic LBP (percentage difference 20% [95% CI 6-33%], RR 2.6 [95% CI 1.3-5.2]) and also LBP < 6 (percentage difference 24% [95% CI 9- 37%], RR 2.3 [95% CI 1.3-4.1]). There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Our findings suggest that PDPH treated with an EBP is associated with an increased prevalence of subsequent low back pain in parturients. The findings of this pilot study should spur further prospective research into identifying potential associations between DP, EBP, and chronic low back pain.

Uso do oxido nitroso como analgésico em parturientes: revisão integrativa

Objetivo: Analisar evidências científicas relacionadas à utilização do oxido nitroso como analgésico em parturientes. Método: Estudo de revisão integrativa da literatura realizado nas bases de dados MEDLINE/Pubmed, CINAHL e LILACS utilizando-se os descritores: Analgesia, Trabalho de parto, Óxido nitroso e seus correspondentes em inglês. A coleta de dados ocorreu de novembro a dezembro de 2018. Resultados: Obteve-se como amostra sete artigos, apresentando, em sua maioria, nível de evidência 2B, colaborando para elaboração de duas categorias temáticas. Evidenciou-se que o óxido nitroso (N2O) é uma medida analgésica eficaz em parturientes, podendo ser utilizado em todos estados do parto, possuindo início de ação em segundos e eliminação rápida, sem comprometer feto e mãe. Quanto a assistência de enfermagem, cabe a coleta de informações, supervisão, avaliação clínica contínua e a administração à parturientes, exigindo uma supervisão e avaliação precisa da vitalidade fetal e bem-estar materno. Conclusão: A utilização do oxido nitroso é uma alternativa segura para o alívio da dor em parturientes. Pretende-se estimular e subsidiar novas pesquisas que trabalhem e aprofundem o uso do oxido nitroso além de outros métodos farmacológicos e não farmacológicos que possam ser aplicados para o alivio da dor durante o parto.

Effect of preoperative education about spinal anesthesia on anxiety and postoperative pain in parturients undergoing elective cesarean section: A randomized controlled trial

Background: Preoperative anxiety is a common problem in all patients. The reason could be incomplete information regarding the anesthesia and surgical procedure. Cesarean section (CS) is a common surgery and treatment of postoperative pain after CS continues to be an ongoing challenge. Aim: The present study was carried out to assess if preoperative education with a handout about spinal anesthesia can reduce anxiety and postoperative pain in parturients undergoing CS under spinal anesthesia. Methods and Materials: We randomized 64 parturients into two equal groups; study (Group A) and control group (Group B). The study group was given a handout and a structured education about spinal anesthesia. The control group was given routine preoperative information. The Amsterdam preoperative anxiety and information scale (APAIS) was used to measure anxiety preoperatively and visual analogue scale (VAS) for pain at 5 h and 24 h postoperatively. Statistical Analysis: The two groups were compared using Student's t test and non-parametric Wilcoxon-Mann-Whitney U test. Result: The median difference in preoperative anxiety scores (APAIS) in the two groups was found to be 8.00 (P

The dose response of sufentanil as an adjuvant to ropivacaine in cesarean section for relief from somato-visceral pain under epidural anesthesia in parturients with scarred uterus.

Visceral pain is common during epidural anesthesia with mini dose local anesthetics in parturients during cesarean section. To reduce or avoid this complication caused by traction on the abdominal viscera, this study aimed to determine the 50% effective dose (ED50) and 95% effective dose (ED95) of epidural sufentanil as an adjuvant combination with local anesthetics for relief visceral pain in parturients with scarred uterus undergoing elective cesarean section.One hundred parturients with scarred uterus undergoing elective cesarean section under epidural anesthesia were enrolled in this randomized, double-blinded, dose-ranging study. Parturients received 5, 10, 15, 20, and 25 μg epidural sufentanil as an adjuvant with 10 mL of 0.65% ropivacaine. Successful epidural anesthesia was defined as a sixth thoracic vertebra (T6) sensory level achieved within 20 minutes after epidural drugs administration and/or no visceral pain by traction on the abdominal viscera during the cesarean section. The ED50 and ED95 were calculated with a logistic regression model.ED50 and ED95 of epidural sufentanil for successful of the pain-free from visceral pain were 10.7 μg [95% confidence interval (CI): 2.4–14.4 μg) and 28.1 μg (95% CI: 19.4–44.0 μg), respectively. The onset time to sensory block, maximum Bromage scale and duration of motor block were significant different with dose of sufentanil >20 μg (P < .05, compared with the other dose groups). With the dose of epidural sufentanil >20 μg could result in an increase of incidence of maternals’ adverse effects. Compared with a different dose of sufentanil, epidural administed sufentanil between 15 μg and 20 μg can maximize parturients’ satisfaction.Our study showed that sufentanil could be used in combination with ropivacaine for relief from somato-visceral pain in patients with scarred uterus during elective cesarean section during epidural anesthesia, and that maximized parturients’ satisfaction could be achieved when the use of sufentanil with the dose between 15 μg and 20 μg for epidural anesthesia.

The Curse of Civilised Woman: Race, Gender and the Pain of Childbirth in Nineteenth-Century American Medicine

Accounts of the easy, painless childbearing of ‘primitive’ non-white women in comparison to their ‘civilised’ white counterparts were ubiquitous in early modern travel literature. In the nineteenth-century United States, such narratives were increasingly taken up in medical and scientific literature, catalysing the production of new forms of knowledge about race and bodies. This article analyses several key medico-scientific theories produced to explain racialised parturient pain and argues that this knowledge dynamically interrelated with both racial ideas and racial practice in nineteenth-century society. The shifting character of this knowledge implicated changing ways of defining race, including the anchoring of racial identity in the physical body; the role of the physician as an arbiter of racial truth; and the imbrication of gender in racial classifications. Moreover, knowledge produced to explain racialised parturient pain – for instance, about race-specific sensory physiology, muscular mechanics and skeletal anatomy – circulated within numerous social institutions, among them slavery; gynaecologic and obstetric care; medical experimentation; anti-abortion crusades invoking the spectre of ‘race suicide’; and eugenic projects. In this way, medical discourse on the gendered body of the parturient was enrolled in the changing articulation of race across the nineteenth century.

Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study

IntroductionWe hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery. MethodsAfter Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150mg or 300mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded. ResultsCompared with placebo or pregabalin 150mg, the use of a preoperative dose of pregabalin 300mg resulted in significantly lower cumulative morphine consumption at 24h (mean dose: placebo 12.9mg [95% CI 11.6 to 14.2]; pregabalin 150mg 11.9mg; [95% CI 10.7 to 13.1]; pregabalin 300mg 6mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300mg resulted in lower pain scores at 4h and 6h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300mg group (6.7%) experienced short-term poor latching-on for breastfeeding. ConclusionIn our study, preoperative administration of pregabalin 300mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.