Management of Incoordinate Uterine Action under Continuous Epidural Analgesia

Introduction: Continuous epidural analgesia has proven to be a good tool in the anaesthetist’s quest to provide excellent pain relief for an extended perioperative period. Pharmaceutical advances provide us with a larger array of both local anaesthetic (LA) drugs and additives that can prolong the duration or enhance the quality of analgesia, or both. The avoidance of LA toxicity is of paramount importance for safe prescription, especially in the high-risk neonatal and infant cohort, and all patients stand to benefit from ‘safer’ LA agents and adjuvants that promote the use of a lowered concentration of epidural LA infusions. We present a descriptive review of trends in epidural prescription and technique in our hospital. Methods: Our observational study was conducted over a period of 19 years in a tertiary paediatric teaching hospital. Prospectively collected data that included patient demographics, level of epidural catheter insertion, LA drugs and adjuvants used, as well as postoperative infusion rates, were then analysed retrospectively. Results: There was a decline in the use of paediatric epidural analgesia. Over the study period, we also observed a shift in preference of LAs and adjuvant drugs toward safer alternatives. Conclusion: Paediatric epidural analgesia is gradually being superseded by other analgesic modalities with superior safety profiles (e.g. peripheral neural blockade). However, indications remain for its continued use, and anaesthetists should be familiar with its technical aspects and pitfalls.

Download Full-text

The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2007.07.006 ◽

2008 ◽

Vol 17 (2) ◽

pp. 123-129 ◽

Cited By ~ 24

Author(s):

V.R.R. Mantha ◽

M.C. Vallejo ◽

V. Ramesh ◽

A.L. Phelps ◽

S. Ramanathan

Keyword(s):

Randomized Controlled Trial ◽

Epidural Analgesia ◽

Controlled Trial ◽

Randomized Controlled ◽

Continuous Epidural Analgesia

Download Full-text

Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽

10.1093/qjmed/hcab086.055 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hala Gomaa Salama ◽

Ahmed Ali El- Shebiny ◽

Abd Al Aziz Abdullah Abd Al Aziz ◽

Mariam Mahmoud Ahmed Ali Shehata

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Nerve Block ◽

Femoral Nerve Block ◽

Weight Bearing ◽

Femoral Nerve ◽

Disease Process ◽

Continuous Epidural Analgesia ◽

Significant Difference ◽

Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

Download Full-text

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

Download Full-text