A Randomized, Double-masked, Multicenter Comparison of the Safety of Continuous Intrathecal Labor Analgesia Using a 28-Gauge Catheter versus  Continuous Epidural Labor Analgesia

Background Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial. Methods Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7-10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status. Results No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post-dural puncture headache, hemodynamic stability, or obstetric outcomes. Conclusions Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia.

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Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

AACN Advanced Critical Care ◽

10.4037/15597768-1991-4013 ◽

1991 ◽

Vol 2 (4) ◽

pp. 729-740 ◽

Cited By ~ 1

Author(s):

Jeanne F. Slack ◽

Margaret Faut-Callahan

Keyword(s):

Critical Care ◽

Pain Relief ◽

Epidural Analgesia ◽

Critically Ill ◽

Nursing Care ◽

Critically Ill Patients ◽

Continuous Epidural Analgesia ◽

Analgesic Agents ◽

Care Problems ◽

Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

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Regional anaesthesia of the trunk

10.1093/med/9780199642045.003.0053 ◽

2017 ◽

Author(s):

Andrew Berrill ◽

Will Jones ◽

David Pegg

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Epidural Analgesia ◽

Regional Anaesthesia ◽

Rectus Sheath ◽

Transversus Abdominis ◽

Respiratory Morbidity ◽

Major Surgery ◽

Analgesic Regimen ◽

Continuous Epidural Analgesia

Analgesia of the thorax and abdomen can be challenging. Surgical incisions are commonly associated with severe postoperative pain. Whilst continuous epidural analgesia remains the ‘gold standard’ in terms of postoperative pain relief after major surgery, there remain concerns regarding rare serious side effects. It has been difficult to demonstrate conclusive evidence of improvement in outcomes when epidural analgesia is used. Superior pain relief and a reduction in postoperative respiratory morbidity are, however, clear advantages of regional anaesthesia. Interest has increased in techniques such as paravertebral and rectus sheath blocks in part due to the ready availability of high-definition portable ultrasound equipment, but also in response to concerns regarding neuraxial blockade and the development of enhanced recovery pathways. In addition, novel approaches to analgesia of the trunk, such as the transversus abdominis plane block, have been developed and are now widely used as part of a multimodal analgesic regimen. In this chapter, techniques of neuraxial and peripheral nerve block are discussed along with their indications and complications.

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The Evaluation of Intravenous Patient Controlled Analgesia and Continuous Epidural Analgesia for Pain Relief after Cesarean Delivery

Korean Journal of Anesthesiology ◽

10.4097/kjae.1998.35.1.125 ◽

1998 ◽

Vol 35 (1) ◽

pp. 125

Author(s):

Youn Soo Kim ◽

Young Kil Choi ◽

Nam Sik Woo

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Cesarean Delivery ◽

Patient Controlled Analgesia ◽

Continuous Epidural Analgesia

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LABOR ANALGESIA IN KIEV (UKRAINE)

Pain anesthesia and intensive care ◽

10.25284/2519-2078.2(95).2021.238306 ◽

2021 ◽

pp. 39-46

Author(s):

I. Kuchyn ◽

D. Govsieiev ◽

K. Bielka ◽

A. Romanenko

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Local Level ◽

The United States ◽

Labor Analgesia ◽

Labor Pain ◽

Maternity Hospitals ◽

Quality Of Medical Care ◽

Pharmacological Method ◽

The Uk

The problem of a labor pain is becoming very important for health care because insufficient analgesia for women during childbirth affects the quality of medical care. The complexity of the use in the system and approaches to providing care to citizens in Ukraine, and at the local level – the interaction of the obstetrician with the women, anaesthetist and also the technical capabilities of public maternity hospitals [1]. For the last decade, epidural analgesia has been the «golden» method in labor analgesia. We searched numerous meta-analyzes about pain management during labor and delivery in the United States, they prefer epidural analgesia in 80-90% of women, while in the UK - 36% [2, 3]. Statistics from around the world indicate a relationship between pain relief and income levels, so in high-income countries, (HICs) women are more likely to be anesthetized during childbirth than in South Africa or Asia [4]. Although childbirth is a physiological and natural process, it needs pain relief. Nowadays a woman’s desire is a sufficient indication for labor analgesia, and this is her right [5]. The problem is to choose a pharmacological and / or non-pharmacological method of analgesia for a particular woman, which will be best for the parturient. It should be noted that there is a separate group of women who choose to give birth at home to reduce the «aggression» of medical staff against women and her child, but they have a higher incidence of complications and increased mortality [6]. «Homebirth» in maternity hospitals helps to solve this problem. A comprehensive questionnaire was created among seven state maternity hospitals in Kyiv to identify the current situation with the provision of maternity care and to analyze the main issues of labor analgesia in Kyiv.

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Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2011.06.041 ◽

2011 ◽

Vol 205 (3) ◽

pp. 271.e1-271.e6 ◽

Cited By ~ 16

Author(s):

Michael L. Haydon ◽

David Larson ◽

Enrique Reed ◽

Vineet K. Shrivastava ◽

Christine W. Preslicka ◽

...

Keyword(s):

Epidural Analgesia ◽

Obstetric Outcomes ◽

Maternal Satisfaction ◽

Nulliparous Women

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28: Obstetric outcomes and maternal satisfaction using patient controlled epidural analgesia in nulliparous women

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2010.10.037 ◽

2011 ◽

Vol 204 (1) ◽

pp. S17

Author(s):

Michael Haydon ◽

David Larson ◽

Enrique Reed ◽

Vineet Shrivastava ◽

Christine Preslicka ◽

...

Keyword(s):

Epidural Analgesia ◽

Obstetric Outcomes ◽

Maternal Satisfaction ◽

Nulliparous Women

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

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.98776 ◽

2012 ◽

Vol 56 (3) ◽

pp. 270 ◽

Cited By ~ 11

Author(s):

Harsha Shanthanna ◽

VinayKumar Manivackam ◽

Medha Huilgol ◽

Amjad Maniar

Keyword(s):

Pain Relief ◽

Total Knee Replacement ◽

Epidural Analgesia ◽

Comparative Study ◽

Knee Replacement ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Nerve Blockade ◽

Continuous Epidural Analgesia ◽

Total Knee

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Birth plan presentation to hospitals and its relation to obstetric outcomes and selected pain relief methods during childbirth

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03739-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Encarnación López-Gimeno ◽

Gemma Falguera-Puig ◽

Mª. Mercedes Vicente-Hernández ◽

Meritxell Angelet ◽

Griselda Vázquez Garreta ◽

...

Keyword(s):

Pain Relief ◽

Confidence Interval ◽

Epidural Analgesia ◽

Study Data ◽

Obstetric Outcomes ◽

Multi Centre Study ◽

Birth Plan ◽

Data Collection Sheet ◽

Health Districts ◽

Do So

Abstract Background The information on birth plan (BP) usage in Spanish hospitals is scant. Aim To identify the percentage of pregnant women presenting a BP at five hospitals in Spain, the reasons why some women failed to do so and how BP presentation relates to obstetric outcomes and selected pain relief methods. Methods In this descriptive, multi-centre study, data were retrospectively collected. During the postpartum visits at primary healthcare centres in various health districts in Barcelona (Catalonia, Spain), a data collection sheet about obstetric outcomes and analgesia was administered to 432 mothers who had completed a BP during their pregnancies. The main outcome was the rate of BP presentation to the hospital. The sociodemographic and obstetric characteristics and pain relief measures were compared to identify any differences between mothers who presented a BP and those who did not. Results A total of 422 (99.7%) women were studied; 51.2% of women (95% confidence interval (CI): 46.4–55.9) had presented a BP. The main reason for not presenting a BP was because the hospital midwives did not request them (61.2%). No differences were observed in BP presentation according to age, the country of origin, education, employment or hospital. Mothers who presented a BP were more likely to start breastfeeding in the birthing room (82.4% vs. 73.3%; p = 0.024). Epidural analgesia was the most common method used for pain relief (88.9%), and women who presented a BP attempted to use concomitant non-pharmacological methods more often (50.5% vs. 38.8%; p = 0.012). Conclusion Almost half of the mothers failed to present a BP, usually because midwives did not request it.

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