CSE for labour analgesia. Roshan Fernando: University College Hospital, London
|
|
|
- Claribel Perkins
- 5 years ago
- Views:
Transcription
1 CSE for labour analgesia Roshan Fernando: University College Hospital, London
2 Lecture outline CSE labour analgesia: indications / technique advantages / disadvantages ambulation recent developments
3 Techniques for labour analgesia Epidural catheter Single shot spinal Spinal microcatheter Combined spinal epidural (CSE)
4 Epidural Slow onset time (15 min) Loading dose low dose mixture: bupivacaine / fentanyl Maintenance regimen low dose mixture: bupivacaine / fentanyl bolus, continuous infusion, PCEA, automatic
5 Combined spinal epidural (spinal) Needle-through-Needle (epidural)
6 Indications for CSE Labour pain early late / 2 nd stage PG induction / oxytocin Rapid delivery / difficult (OP position) Failed regional block
7 Low dose CSE (labour) rapid analgesia maternal distress advanced labour sacral analgesia
8 Typical CSE regimen Spinal 2.5 mg bupivacaine µg fentanyl 3 ml of epidural low dose mixture Epidural (low dose mix = 0.1 % bupiv + 2 µg/ml fentanyl) intermittent bolus / continuous infusion PCEA automated intermittent bolus
9 CSE vs. epidural Regional labour analgesia CSE Epidural
10 CSE vs. epidural Regional labour analgesia CSE Epidural Spinal starter 2.5 mg bupiv µg fentanyl 2.5 mg bupiv µg sufentanil 3ml low dose epidural mixture Epidural topup 15ml low dose epidural mixture 0.1% bupiv + 2µg/ml fentanyl % bupiv µg/ml sufent CI / PCEA / automatic bolus
11 CSE vs. epidural Regional labour analgesia CSE Epidural Spinal starter 2.5 mg bupiv + 25 µg fentanyl 2.5 mg bupiv µg sufentanil 3ml low dose epidural mixture Epidural topup 15ml low dose epidural mixture 0.1% bupiv + 2µg/ml fentanyl % bupiv µg/ml sufent CI / PCEA / automatic bolus Epidural starter 15ml low dose epidural mixture 0.1% bupiv + 2µg/ml fentanyl % bupiv µg/ml sufent Epidural topup 15ml low dose epidural mixture CI / PCEA / automatic bolus
12 Automatic epidural bolus Yvonne Lim / Alex Sia IJOA 05 Automated epidural bolus vs continuous infusion A new way of giving epidural labor analgesia Not: nurse bolus on demand / continuous infusion / PCEA Automatic epidural bolus at regular intervals
13 Lecture outline CSE labour analgesia: indications / technique advantages / disadvantages ambulation / safety recent developments
14 CSE: advantages / disadvantages CSE Advantages Disadvantages Efficacy speed, sacral blk Obstetric outcome normal deliveries Ambulation lower limb motor blk Failure / technical issues Headache (PDPH) Testing of epidural catheter Fetal bradycardia Miscellaneous meningitis, nerve damage, metallic fragments, catheter migration
15 CSE : advantages / disadvantages CSE Advantages Disadvantages Efficacy speed, sacral blk Obstetric outcome normal deliveries Ambulation lower limb motor blk Failure / technical issues Headache (PDPH) Testing of epidural catheter Fetal bradycardia Miscellaneous meningitis, nerve damage, metallic fragments, catheter migration
16 CSE : advantages / disadvantages CSE Advantages Disadvantages Efficacy speed, sacral blk Obstetric outcome normal deliveries Ambulation lower limb motor blk Failure / technical issues Headache (PDPH) Testing of epidural catheter Fetal bradycardia Miscellaneous meningitis, nerve damage, pruritus metallic fragments, catheter migration
17 CSE : advantages Advantages Efficacy Obstetric outcome Ambulation fast onset time: < 5-10 min sacral analgesia late 1 st stage / 2 nd stage distressed mothers failed epidural
18 CSE : advantages Advantages Efficacy II Obstetric outcome Ambulation epid LDM straight after spinal breakthrough pain bupivacaine requirements
19 CSE : advantages Advantages Efficacy Obstetric outcome Ambulation no differences! normal deliveries forceps / ventouse caesarean section
20 CSE : advantages Advantages Efficacy Obstetric outcome Ambulation possible also with epidural both motor block safety issues balance function
21 Walking CSE /epidural
22 Ambulation & obstetric outcome Nikodem Cochrane 93 / 94 Gupta Cochrane 03 Nageotte NEJM 97 Bloom NEJM 98 Collis Anaesthesia 99 Tsen Anesthesiology 99 Karraz Int J Gyne & Obst 03 Frenea Anesth Analg 04
23 Ambulation & obstetric outcome Collis 99 CSE: ambulant vs. lying Tsen 99 CSE vs. epidural: cervical dilatation with CSE Karraz 03 / Vallejo 01 epidural: ambulant vs. lying Frenea 04 epidural: prolonged ambulation
24 Is walking safe after low dose CSE / epidural? Are falls more likely?
25 Balance function somatosensory / visual / vestibular
26 Can you prevent a fall with a test? Lower limb motor power straight leg raising against resistance Dorsal column function proprioception / Romberg s test vibration Partial knee bend Step on/off foot stool
27 CDP: Computerized Dynamic Posturography Equitest Balance Master 6.1
28 Jeremy Davies Tony Pickering Andy McLeod
29 Posturography: Balance Master 6.1
30 Davies 02 (Anesthesiology) Balance Master 6.1 Pregnant control no epidural
31 Davies 02 (Anesthesiology) Balance Master 6.1 Labouring mother 30 min after CSE
32 Davies 02 (Anesthesiology) 50 non-pregnant controls vs 50 pregnant controls vs 50 pregnant after low dose CSE Non-pregnant controls better scores in 6/13 tests vs pregnant and CSE gps No difference between CSE and pregnant control!
33 Summary: balance function after CSE Pregnant women balance function Labour CSE (spinal) does not affect balance Epidural top-ups may balance function
34 CSE : disadvantages Disadvantages Failure PDPH Epidural testing Fetal bradycardia with experience: < 0.4% needle movement inadequate drug dose
35 CSE : disadvantages Disadvantages Failure PDPH Epidural testing Fetal bradycardia headache risk < 0.1% use pencilpoint needles avoid multiple passes of spinal needle
36 CSE : disadvantages Disadvantages Failure PDPH Epidural testing Fetal bradycardia can an epidural catheter be tested after spinal? epidural test dose not reliable use multi-hole epidural catheter aspiration detects most iv catheters fractionate high dose LA for caesarean section
37 CSE : disadvantages Disadvantages Failure PDPH Epidural testing Fetal bradycardia CSE = Epidural CTG Cord blood gases Apgar scores
38 CSE & fetal bradycardia Mardirosoff (2002) metaanalysis fetal bradycardia with spinal opioids Van de Velde (2004) epidural vs. CSE high / low dose sufentanil spinal opioid dose fetal bradycardia (7µg sufent) Rapid analgesia epinephrine / norepinephrine imbalance uterine hypertonus (?)
39 CSE : disadvantages Disadvantages Miscellaneous Meningitis Nerve damage Catheter migration Metallic fragments
40 CSE : disadvantages Disadvantages Miscellaneous Meningitis Nerve damage Catheter migration Metallic fragments
41 CSE : disadvantages Disadvantages Miscellaneous Meningitis Nerve damage Catheter migration Metallic fragments spinal needle puncture epidural catheter radius
42 CSE : disadvantages Disadvantages Miscellaneous Meningitis Nerve damage Catheter migration Metallic fragments spinal needle scratch manufacturing scratch
43 CSE : disadvantages Pruritus with spinal opioids dose dependent treatment available Respiratory depression very rare event / dose dependent high dose sufentanil early days of CSE!
44 CSE - recent developments Bupivacaine vs. levobupivacaine vs. ropivacaine Camorcia 05 / Van de Velde 07 Effect of spinal injection volume Parpaglioni 05; injection vol efficacy CSE vs. epidural analgesia outcomes Thomas 05; no difference
45 CSE - recent developments Bupivacaine vs. levobupivacaine vs. ropivacaine Camorcia 05 / Van de Velde 07
46 Bupiv vs. levo vs. ropiv Camorcia MLAD / ED50 study potency: bupiv > levo > ropiv Van de Velde full dose response study (ED95 + ED50) potency: bupiv > levo & ropiv
47 CSE - recent developments Bupivacaine vs. levobupivacaine vs. ropivacaine Camorcia 05 / Van de Velde 07 Effect of spinal injection volume Parpaglioni 05 CSE vs. epidural outcomes Thomas 05
48 CSE - spinal inj volume Parpaglioni Anesthesiology Effect of different volumes of spinal levobup for labour Spinal levobupivacaine at different volumes (2.5, 5 & 10ml; n=93) Up / down sequential allocation MLAD (mg) injection volume MLAD vol effect Spinal volume (ml)
49 CSE - recent developments Bupivacaine vs. levobupivacaine vs. ropivacaine Camorcia 05 / Van de Velde 07 Effect of spinal injection volume Parpaglioni 05 CSE vs. epidural - outcomes Thomas 05
50 CSE outcome Thomas Anesthesiology Does dural puncture during CSE improve epid function? CSE without spinal drug injection vs epidural catheter only technique PCEA analgesia with low dose fent/bupiv No group differences: epidural catheter manipulation / replacement unilateral blocks / analgesia quality
51 CSE the future? Epidurals for early labour CSE late labour / maternal distress difficult delivery / failed epidural Spinal volume effects Analgesia maintenance (automated bolus)
52 Thank you!
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions?
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions? Dr Mark Esler Queen Charlotte s and Chelsea Hospital Imperial College Healthcare NHS Trust 2 nd October 2013 2 kangaroos and
Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C.
CSE s for Labor Analgesia PRO! Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C. Tsen, MD Director of
Y. Lim, 1 A. T. Sia 2 and C. E. Ocampo 3
Anaesthesia, 2006, 61, pages 339 344 doi:10.1111/j.1365-2044.2006.04535.x Comparison of computer integrated patient controlled epidural analgesia vs. conventional patient controlled epidural analgesia
Combined spinalepidural. epidural analgesia in labour (review) By Neda Taghizadeh
Combined spinalepidural versus epidural analgesia in labour (review) By Neda Taghizadeh Cochrane review Cochrane collaboration was founded in 1993 and is named after Archie Cochrane (1909-1988), British
Epidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
Original article Pravara Med Rev 2010; 2(3)
Original article Pravara Med Rev 2010; 2(3) A randomized clinical trial to compare continuous epidural infusion technique with that of intermittent boluses for maintenance of epidural labour analgesia
Labor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
CSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour
CSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour Dr Jason Reidy Nuffield Department of Anaesthetics Oxford University Hospitals CSE analgesia does not represent the gold standard
Combined spinal-epidural analgesia represents the gold standard for regional analgesia in labour
Combined spinal-epidural analgesia represents the gold standard for regional analgesia in labour Felicity Plaat Queen Charlotte s Hospital, Imperial College NHS Trust London Combined spinal-epidural analgesia
Labour Regional Analgesia for the 21st Century
Labour Regional Analgesia for the 21st Century What Really Matters? A Darwinian Adventure Obstetric Anaesthesia 2012 Lawrence C. Tsen, MD Vice Chair, Department of Anesthesiology, Perioperative & Pain
Maternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES. Dr Bernard J Norman November 2012
Maternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES Dr Bernard J Norman November 2012 Mother Fetus Mother The Birth of Queen Victoria s Eighth Child, Prince Leopold,
Combined spinal-epidural versus epidural analgesia in labour (Review)
Combined spinal- versus analgesia in labour (Review) Simmons SW, Cyna AM, Dennis AT, Hughes D This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published
Almost two decades have passed since French and American trials
PERIODICUM BIOLOGORUM UDC 57:61 VOL. 111, No 2, 171 185, 2009 CODEN PDBIAD ISSN 0031-5362 Review Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection MARC VAN DE VELDE
Safety and quality of neuraxial analgesia. Ulla Sipiläinen HUCS Jorvi hospital
Safety and quality of neuraxial analgesia Ulla Sipiläinen 6.10. 2011 HUCS Jorvi hospital Chestnut s Checklist Preparation for neuraxial labor analgesia 1.Communicate (early) with obst provider review parturient
Combined Spinal epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study
ORIGINAL ARTICLE Combined Spinal epidural with Levobupivacaine or Ropivacaine 10.5005/jp-journals-10050-10080 with Fentanyl for Labor Analgesia Combined Spinal epidural with Levobupivacaine or Ropivacaine
Initiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany
Initiating Labour Analgesia in 2020: Predicting the Future Epidurals, CSEs, Spinal Catheters, Epidrum & Epiphany Kenneth E Nelson, M.D. Associate Professor Wake Forest University, North Carolina, USA Initiating
Faculty Development Talk
Faculty Development Talk Updates in Obstetric Anaesthesia Leong Wan Ling Consultant, Women s Anaesthesia, KK Women s & Children s Hospital 13 th September 2017 Topics Labour ward Neuraxial anaesthesia
Cesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors
Cesarean Section Should be Managed: Low Dose / CSE versus High Dose Spinals with Vasopressors Cristian Arzola MD MSc Department of Anesthesia and Pain Management Mount Sinai Hospital and University of
LOW CONCENTRATION LIDOCAINE (0.5%) BOLUS EPIDURALLY CAN INITIATE FAST-ONSET, EFFECTIVE AND SAFE ANALGESIA FOR EARLY STAGE LABOR
LOW CONCENTRATION LIDOCAINE (0.5%) BOLUS EPIDURALLY CAN INITIATE FAST-ONSET, EFFECTIVE AND SAFE ANALGESIA FOR EARLY STAGE LABOR Henry Liu * 1,2, Shanglong Yao **1, Frank Rosinia *2 Abstract There is no
Although intrathecal (IT) sufentanil provides effective
Combination of Intrathecal Sufentanil 10 g Plus Bupivacaine 2.5 mg for Labor Analgesia: Is Half the Dose Enough? Alex T. H. Sia, MMed, Jin L. Chong, MMed, and Jen W. Chiu, MMed Department of Anesthesia,
NEW MODES OF OBSTETRIC ANALGESIA: DOES PIEB MODE BRING A REAL BENEFIT?
NEW MODES OF OBSTETRIC ANALGESIA: DOES PIEB MODE BRING A REAL BENEFIT? Hawa KEITA-MEYER SERVICE D ANESTHÉSIE. HÔPITAL LOUIS MOURIER, COLOMBES. LABOR PAIN Melzack R. Pain 1984; 19(4): 321-337 LABOR STAGES
Mitra et al. Sri Lankan Journal of Anaesthesiology: 23(2):61-65(2015) DOI: /slja.v23i2.8068
DOI: 10.4038/slja.v23i2.8068 Evaluation of analgesic efficacy of the combination of fentanyl with low dose bupivacaine vs ropivacaine using patient controlled epidural analgesia for control of labour pain-
The Labour Epidural: Troubleshooting
O B S T E T R I C A N A E S T H E S I A Tutorial 366 The Labour Epidural: Troubleshooting Dr Charlotte Kingsley Anaesthetic Registrar, Royal Free Hospital, UK Dr Alan McGlennan Consultant Anaesthetist,
Epidural Analgesia in Labor - Whats s New
Epidural Analgesia in Labor - Whats s New Wichelewski Josef 821 Selective neural blockade has many clinical applications in medicine but nowhere has its use been so well accepted than in the field of Obstetrics.
Regional Anaesthesia for Caesarean Section
Regional Anaesthesia for Caesarean Section "The Best Recipe" Warwick D. Ngan Kee Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong What I will not do. Magic recipes One shoe to fit
The right drug and dose for neuraxial labour analgesia
(Acta Anaesth. Belg., 2006, 57, 395-399) The right drug and dose for neuraxial labour analgesia P. Y. DEWANDRE INTRODUCTION Neuraxial analgesia has been demonstrated for many years to be the only safe
T. GIRARD ( 1 ), C. KERN ( 2 ), I. HÖSLI ( 3 ), A. Heck ( 4 ) and M. C. SCHNEIDER ( 1 )
(Acta Anaesth. Belg., 2006, 57, 45-49) Ropivacaine versus Bupivacaine 0.125% with Fentanyl 1µg/ml for Epidural Labour Analgesia : Is Daily Practice More Important Than Pharmaceutical Choice? T. GIRARD
Introduction of a New Concept of Pain Management during Labor and a Novel Technique for Pain Free Labor
Open Journal of Anesthesiology, 2012, 2, 79-83 http://dx.doi.org/10.4236/ojanes.2012.23019 Published Online July 2012 (http://www.scirp.org/journal/ojanes) 1 Introduction of a New Concept of Pain Management
Success going from failure to failure without loss of enthusiasm
Success going from failure to failure without loss of enthusiasm Failure of neuraxial analgesia: factors within & beyond our control tips, trick & solutions science, evidence & guidance Dr Matt Wilson
Topping up the epidural for emergency caesarean section
Topping up the epidural for emergency caesarean section Mark Cox Lead Obstetric Anaesthetist Chelsea and Westminster Hospital Tell the patient it may not work Pain; GA Top it up or take it out? What drugs?
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee
Regional Anaesthesia for Caesarean Section Warwick D. Ngan Kee Chair, Department of Anesthesiology Sidra Medicine Doha, Qatar D I S C L O S U R E S No financial disclosures No industry affiliations No
COMPLICATIONS AND INTERVENTIONS ASSOCIATED WITH EPIDURAL ANALGESIA FOR POSTOPERATIVE PAIN RELIEF IN A TERTIARY CARE HOSPITAL
COMPLICATIONS AND INTERVENTIONS ASSOCIATED WITH EPIDURAL ANALGESIA FOR POSTOPERATIVE PAIN RELIEF IN A TERTIARY CARE HOSPITAL Faraz Shafiq *, Mohammad Hamid ** and Khalid Samad *** Introduction Epidural
Combined Spinal- Epidural in Labor Analgesia: Comparison of Fentanyl Bupivacaine Mixture versus Sufentanil - Bupivacaine Mixture
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2018/216 Combined Spinal- Epidural in Labor Analgesia: Comparison of Fentanyl Bupivacaine Mixture versus Sufentanil - Bupivacaine
Obstetrical Anesthesia. Safe Pain Relief for Childbirth
Obstetrical Anesthesia Safe Pain Relief for Childbirth Introduction Pain relief (analgesia) for labor and delivery is now safer than ever. In the United States approximately two-thirds of all women receive
PAIN AND REGIONAL ANESTHESIA
PAIN AND REGIONAL ANESTHESIA Anesthesiology 2007; 106:149 56 Copyright 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Determination of the Full Dose Response
What s new in obstetric anesthesia?
SAOA 2013 - SPRING MEETING BERN What s new in obstetric anesthesia? PD Dr. Med Georges Savoldelli Médecin Adjoint Unité d anesthésiologie gynéco-obstétricale Service d Anesthésiologie, HUG An objectively
Role and safety of epidural analgesia
Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,
Remifentanil in labour analgesia where are we in 2017 an update.
Remifentanil in labour analgesia where are we in 2017 an update. Vegard Dahl, Head of Dept of Anaesthesia and Intensive Care, Professor, Akershus University Hospital, Norway Disclosures None Agenda Pharmacology
Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
David Gambling, MB, BS,* Jonathan Berkowitz, PhD, Thomas R. Farrell, MD, Alex Pue, MD,* and Dennis Shay, MD*
Society for Obstetric Anesthesia and Perinatology Section Editor: Cynthia A. Wong CME A Randomized Controlled Comparison of Epidural Analgesia and Combined Spinal-Epidural Analgesia in a Private Practice
Combined Spinal Epidural versus Epidural Labor Analgesia Mark C. Norris, M.D.,* Steven T. Fogel, M.D., Carol Conway-Long, R.N.
Anesthesiology 2001; 95:913 20 2001 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Combined Spinal versus Labor Analgesia Mark C. Norris, M.D.,* Steven T. Fogel, M.D.,
COMBINED SPINAL EPIDURAL ANAESTHESIA TECHNIQUE IN OBSTETRICS
COMBINED SPINAL EPIDURAL ANAESTHESIA TECHNIQUE IN OBSTETRICS Andre Van Zundert Catharina Hospital Eindhoven The Netherlands Introduction The combined spinal-epidural anesthesia technique (CSE) has been
CAESAREAN SECTION Brian Fredman
CHAPTER 3 GYNAECOLOGICAL SURGERY CAESAREAN SECTION Brian Fredman Review of evidence: surgical site infusion Of the seven studies on surgical site local anaesthetic infusion after Caesarean section performed
Continuous Spinal Anaesthesia
Continuous Spinal Anaesthesia Ph. Biboulet Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier France CSA story : 1906 Dean 1944 Tuohy 1991 CSA revisited
Although epidural bupivacaine is highly effective
Original Article 286 Comparison between 0.08% Ropivacaine and 0.06% Levobupivacaine for Epidural Analgesia during Nulliparous Labor: A Retrospective Study in A Single Center Hui-Ling Lee, MD; Liang-Ming
Impact of Drug Delivery Systems on Neuraxial Labor Analgesia
Curr Anesthesiol Rep (2013) 3:275 281 DOI 10.1007/s40140-013-0030-9 OBSTETRICAL ANESTHESIA (LR LEFFERT, SECTION EDITOR) Impact of Drug Delivery Systems on Neuraxial Labor Analgesia Srividhya Jayant Iyer
COMPARISON OF % BUPIVACAINE WITH % FENTANYL V/S % BUPIVACAINE IN AMBULATORY LABOR EPIDURAL ANALGESIA
ORIGINAL ARTICLE COMPARISON OF 0.0625% BUPIVACAINE WITH 0.0002% FENTANYL V/S 0.0125% BUPIVACAINE IN AMBULATORY LABOR EPIDURAL ANALGESIA Vibha Mehta, Sumitra Kanojiya Associate Professor, Department of
DURAL PUNCTURE EPIDURAL ANALGESIA IS NOT SUPERIOR TO CONTINUOUS LABOR EPIDURAL ANALGESIA
DURAL PUNCTURE EPIDURAL ANALGESIA IS NOT SUPERIOR TO CONTINUOUS LABOR EPIDURAL ANALGESIA Deepak Gupta *, Arvind Srirajakalidindi *, Vitaly Soskin ** Abstract Background: Some anesthesiologists consider
Regional Anesthesia. Fatiş Altındaş Dept. of Anesthesiology
Regional Anesthesia Fatiş Altındaş Dept. of Anesthesiology Regional anesthesia - Definition Renders a specific area of the body, e.g. foot, arm, lower extremities insensating to stimulus of surgery or
Combined spinal epidural analgesia for labor and delivery : a balanced view based on experience and literature
(Acta Anaesth. Belg., 2009, 60, 109-122) Combined spinal epidural analgesia for labor and delivery : a balanced view based on experience and literature M. VAN DE VELDE INTRODUCTION Almost two decades have
OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
British Journal of Anaesthesia 98 (2): 241 5 (2007) doi:10.1093/bja/ael346 Advance Access publication January 8, 2007 OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
Comparison between Patient-Controlled Epidural Analgesia and Continuous Epidural Infusion for Pain Relief after Gynaecological Surgery
Original Research Article Comparison between Patient-Controlled Epidural Analgesia and Continuous Epidural Infusion for Pain Relief after Gynaecological Surgery Suhaila N 1, Nurlia Y 2 ( ), Azmil Farid
Assistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
Pain Relief Options for Labor. Providing you with quality care, information and support
Pain Relief Options for Labor Providing you with quality care, information and support What can I expect during my labor and delivery? As a patient in the Labor and Delivery suite at Lucile Packard Children
Local Anaesthetic Systemic Toxicity (LAST)
Local Anaesthetic Systemic Toxicity (LAST) Part II Course, June 2012 Dr Michael Barrington St Vincent s Hospital, Melbourne History LAST quickly became noted as a serious complication after introduction
Title: Epidural Analgesia for Pain Management in Labour. Date: May 03, 2007
Title: Epidural Analgesia for Pain Management in Labour Date: May 03, 2007 Context and policy issues: Balancing pain control with unwanted maternal and neonatal effects remains a hotly debated topic for
Post-caesarean analgesia. Genevieve Goulding Royal Brisbane & Women's Hospital 1
Post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's Hospital 1 Contemporary challenges & barriers to providing optimal post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's
section: levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentanyl 2 µg/ml: a comparative study
Clinical research Patient-controlled epidural analgesia after Caesarean section: levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentanyl 2 µg/ml: a comparative study Paraskevi Matsota,
Epidural analgesia in labour Guideline for care
This is an official Northern Trust policy and should not be edited in any way Epidural analgesia in labour Guideline for care Reference Number: NHSCT/12/523 Target audience: This policy is directed to
REVISTA BRASILEIRA DE ANESTESIOLOGIA
Rev Bras Anestesiol. 2013;63(3):267-272 DOI: 10.1016/S0034-7094(13)70229-0 REVISTA BRASILEIRA DE ANESTESIOLOGIA Official Publication of the Brazilian Society of Anesthesiology www.sba.com.br SCIENTIFIC
Int J Clin Exp Med 2018;11(8): /ISSN: /IJCEM
Int J Clin Exp Med 2018;11(8):8003-8010 www.ijcem.com /ISSN:1940-5901/IJCEM0078281 Original Article Efficacy and side effects comparison of bupivacaine and ropivacaine with fentanyl for labor analgesia
Comparison of 0.125% ropivacaine-dexmedetomidine versus 0.125% levobupivacaine-dexmedetomidine for epidural labour analgesia
Comparison of 0.125% ropivacaine-dexmedetomidine versus 0.125% levobupivacaine-dexmedetomidine for epidural labour analgesia ABSTRACT Background: Levobupivacine and Ropivacaine are two new local anaesthetics
Remifentanil PCA In Labor
Remifentanil PCA In { Jennifer Lucero, MD Clinical Instructor UCSF Department of Anesthesia Remifentanil PCA in Discuss the Pharmokinectics of Remifentanil Review literature on the use of Remifentanil
Pharmacologic Pain Relief: It s Use in Labor
Pharmacologic Pain Relief: It s Use in Labor Linda Robinson MSN, RNC Clinical Nurse Specialist, Northwest Hospital Fall, 2016 Objectives Recognize common medications used in the management of labor pain
Keywords: Bupivacaine, Haemodynamic Alteration, Levobupivacaine, Spinal Anaesthesia, Transurethral Resection of Prostate
A CLINICAL TRIAL COMPARING LEVOBUPIVACAINE, STANDARD AND LOW DOSE BUPIVACAINE FOR SUBARACHNOID BLOCK TO COMPARE THE HAEMODYNAMIC CHANGES AS WELL AS EFFECT ON EARLY AMBULATION IN PATIENTS UNDERGOING TRANS
Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia
ISPUB.COM The Internet Journal of Anesthesiology Volume 33 Number 1 Efficacy Of Ropivacaine - Fentanyl In Comparison To Bupivacaine - Fentanyl In Epidural Anaesthesia S Gautam, S Singh, R Verma, S Kumar,
PAIN AND REGIONAL ANESTHESIA. Materials and Methods
PAIN AND REGIONAL ANESTHESIA Anesthesiology 2004; 101:439 44 2004 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Epidural Neostigmine Combined with Sufentanil Provides
OBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section
British Journal of Anaesthesia 98 (6): 792 6 (2007) doi:10.1093/bja/aem101 Advance Access publication May 3, 2007 OBSTETRICS Effects of intrathecal and i.v. small-dose sufentanil on the median effective
術後止痛新潮流 - 區域神經止痛術.
The clinical implication of peripheral nerve block ( including the techniques of single shot & continuous catheter) The current status of peripheral nerve block technique in USA, Singapore and Taiwan 台大醫院麻醉部陳李魁醫師助理教授
Epidural Volume Extension In Combined Spinal Epidural Anaesthesia For Rapid Motor Recovery After Elective Caesarean SectionA Comparative Study
ISPUB.COM The Internet Journal of Anesthesiology Volume 30 Number 4 Epidural Volume Extension In Combined Spinal Epidural Anaesthesia For Rapid Motor Recovery After Elective Caesarean SectionA Comparative
What s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
Regional Anesthesia. procedure if required. However, many patients prefer to receive sedation either during the
1 Regional Anesthesia Regional anaesthesia (or regional anesthesia) is anesthesia affecting only a large part of the body, such as a limb or the lower half of the body. Regional anaesthetic techniques
M.E. Bauer, a J.A. Kountanis, a L.C. Tsen, b M.L. Greenfield, a J.M. Mhyre a ORIGINAL ARTICLE. Introduction
International Journal of Obstetric Anesthesia (2012) 21, 294 309 0959-289X/$ - see front matter c 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijoa.2012.05.007 ORIGINAL ARTICLE Risk
The Croatian viewpoint for labour analgesia and anaesthesia
Spring Congres of the Finish Society of Anaesthesiologist (Obstetric Anaesthesia branch, SOAT) The Croatian viewpoint for labour analgesia and anaesthesia Dragica Kopic,MD, Department of Anaesthesiology
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland
Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1
Is There an Ideal Regimen for CPNB?
Is There an Ideal Regimen for CPNB? Dr Eric Albrecht, MD, DESA Department of Anesthesiology, CHUV 2nd SARA Annual Symposium June 2013 Manuel pratique d ALR échoguidé, Elsevier Masson, Paris, 2013 Albrecht
Continuous spinal analgesia via a spinal catheter
Continuous Spinal Analgesia for Labor and Delivery: An Observational Study with a 23-Gauge Spinal Catheter Weike Tao, MD,* Erica N. Grant, MD, MSc,* Margaret G. Craig, MD,* Donald D. McIntire, PhD, and
Trust Guideline for the Management of Inadvertent Dural Puncture and Post Dural Puncture Headache in Obstetrics
A clinical guideline recommended for use In: By: For: Key words: Written by: Delivery Suite All Anaesthetic Staff Women in labour who have had an inadvertent dural puncture when having an epidural sited
Sri Lankan Journal of Anaesthesiology 17(2) : (2009)
Sri Lankan Journal of Anaesthesiology 17(2) : 55-60 (2009) COMPARISON OF PROPHYLACTIC INTRAMUSCULAR EPHEDRINE WITH PRELOADING VERSUS PRELOADING ALONE IN PREVENTION OF HYPOTENSION DURING ELECTIVE CAESAREAN
Epidural Analgesia during Labor
Epidural Analgesia during Labor THE POSITION OF WOMAN IN ANY CIVILIZATION IS AN INDEX OF THE ADVANCEMENT OF THAT CIVILIZATION; THE POSITION OF WOMAN IS GAUGED BEST BY THE CARE GIVEN TO HER AT THE BIRTH
Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis
International Journal of Obstetric Anesthesia (2013) 22, 26 30 0959-289X/$ - see front matter c 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijoa.2012.10.004 REVIEW ARTICLE Insertion
Intermittent Epidural Bolus Compared with Continuous Epidural Infusions for Labor Analgesia: A Systematic Review and Meta-Analysis
Intermittent Epidural Bolus Compared with Continuous Epidural Infusions for Labor Analgesia: A Systematic Review and Meta-Analysis Ronald B. George, MD, FRCPC, * Terrence K. Allen, MBBS, FRCA, and Ashraf
EPiMAP Obstetrics European Practices in the Management of Accidental Dural Puncture in Obstetrics
Appendix 3: Pre-study Questionnaire EPiMAP Obstetrics European Practices in the Management of Accidental Dural Puncture in Obstetrics All questions in this questionnaire relate to the situation in 2014
Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery
ISPUB.COM The Internet Journal of Anesthesiology Volume 30 Number 4 Comparison Of Intrathecal Hyperbaric Ropivacaine And Bupivacaine For Caesarean Delivery U Srivastava, K Joshi, A Gupta, Y Dwivedi, H
Pharmacologic Pain Relief: It s Use in Labor. Linda Robinson MSN, RNC Clinical Nurse Specialist, Northwest Hospital Spring, 2016
Pharmacologic Pain Relief: It s Use in Labor Linda Robinson MSN, RNC Clinical Nurse Specialist, Northwest Hospital Spring, 2016 Objectives Recognize common medications used in the management of labor pain
Comparison of combined spinal-epidural and low dose epidural for labour analgesia
232 REPORTS OF INVESTIGATION Comparison of combined spinal-epidural and low dose epidural for labour analgesia David L. Hepner MD,* Robert R. Gaiser MD, Theodore G. Cheek MD, Brett B. Gutsche MD Purpose:
INTRATHECAL FENTANYL ADDED TO LIDOCAINE FOR CESAREAN DELIVERY UNDER SPINAL ANESTHESIA
INTRATHECAL FENTANYL ADDED TO LIDOCAINE FOR CESAREAN DELIVERY UNDER SPINAL ANESTHESIA - A Randomised Clinical Trial - * AND KHOOSHIDEH M ** Abstract The addition of opioids to local anesthetics improves
Comparative Study of Intrathecal Ropivacaine and Levobupivacaine With Fentanyl And Magnesium As Adjuvants For Lower Abdominal Surgeries
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-853, p-issn: 2279-861. Volume 13, Issue 5 Ver. II. (May. 214), PP 39-43 Comparative Study of Intrathecal Ropivacaine and Levobupivacaine
Merja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
Long-acting opioids in obstetric analgesia and the newborn Merja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
Post-Dural Puncture Headache. Dr. Jacobs Aurélie Krans Anesthesie 18/03/2016 Kliniek St.-Jan, Brussel
Post-Dural Puncture Headache Dr. Jacobs Aurélie Krans Anesthesie 18/03/2016 Kliniek St.-Jan, Brussel I - PATHOPHYSIOLOGY August Bier (intrathecal cocaïn1898)! first 2 cases PDPH CSF leak trough dura mater
Parecoxib, Celecoxib and Paracetamol for Post Caesarean Analgesia: A Randomised Controlled Trial
Parecoxib, Celecoxib and Paracetamol for Post Caesarean Analgesia: A Randomised Controlled Trial McDonnell NJ, Paech MJ, Baber C, Nathan E Clinical Associate Professor Nolan McDonnell School of Medicine
A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with % bupivacaine with 0.
International Journal of Research in Medical Sciences Kanna V et al. Int J Res Med Sci. 2015 Oct;3(10):2553-2560 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150789
Epidural Analgesia with Amide Local Anesthetics, Bupivacaine, and Ropivacaine in Combination with Fentanyl for Labor Pain Relief: A Meta-Analysis
e-issn 1643-3750 Med Sci Monit, 15; 21: 921-928 DOI: 10.12659/MSM.892276 Received: 14.08.19 Accepted: 14.10.24 Published: 15.03.29 Epidural Analgesia with Amide Local Anesthetics, Bupivacaine, and Ropivacaine
What to do if a neuraxial block in a pa(r)t(ur)ient spreads too cephalad soon after injection?
What to do if a neuraxial block in a pa(r)t(ur)ient spreads too cephalad soon after injection? Marcel Vercauteren 751 When a segmental block is intended, the appearance of signs of a block where it was
OBSTETRICS Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for Caesarean section
OBSTETRICS Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for Caesarean section M. C. Hennebry 1, G. M. Stocks 1 *, P. Belavadi 1, J. Barnes 1,S.Wray 1,
A 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics at a Tertiary-Care Medical Center
Research Article TheScientificWorldJOURNAL (2009) 9, 715 722 ISSN 1537-744X; DOI 10.1100/tsw.2009.94 A 5-Year Audit of Accidental Dural Punctures, Postdural Puncture Headaches, and Failed Regional Anesthetics
COMPARISON OF INCREMENTAL SPINAL ANAESTHESIA USING A 32-GAUGE CATHETER WITH EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION
British Journal of Anaesthesia 1991; 66: 232-236 COMPARISON OF INCREMENTAL SPINAL ANAESTHESIA USING A 32-GAUGE CATHETER WITH EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION I. G. KESTIN, A. P. MADDEN,
THE earliest reports of neuraxial analgesia for labor
Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia A Randomized Clinical Trial Elizabeth M. S. Lange, M.D., Cynthia A. Wong, M.D., Paul C. Fitzgerald, R.N., M.S., Wilmer
Patient-controlled epidural analgesia for labor
Obstetric Anesthesiology Section Editor: Cynthia A. Wong Focused Review Patient-Controlled Epidural Analgesia for Labor Stephen H. Halpern, MD, MSc, FRCPC* Brendan Carvalho, MBBCh, FRCA Patient-controlled
Bupivacaine Augments Intrathecal Fentanyl for
84 Anesthesiology 1999; 91:84-9 0 1999 American Society of Anrsthrsiologists, Inc Lippincott Williams Sr Wilkins, hc. Bupivacaine Augments Intrathecal Fentanyl for Labor Analgesia Craig M. Palmer, M. D.,*