scholarly journals Comparison of effects of low dose ropivacaine with levobupivacaine on quality of analgesia, maternal satisfaction and neonatal outcome during labor through combined spinal epidural approach: A double blind randomized study

2021 ◽  
Vol 8 (2) ◽  
pp. 230-235
Author(s):  
Shruti Sharma ◽  
Archana Agarwal ◽  
Trilok Chand ◽  
Unni Jithendran
Keyword(s):  
Randomized Study ◽  
Labor Analgesia ◽  
Statistical Testing ◽  
Secondary Outcome ◽  
Epidural Administration ◽  
Maternal Satisfaction ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Regional techniques in labor analgesia have proven to be very effective, with bupivacaine being the most commonly used drug. This study compares the efficacy of local anaesthetics with lower cardiotoxicity and neurotoxicity such as levobupivacaine and ropivacaine in low doses, administered intrathecally followed by Patient Controlled Epidural Analgesia (PCEA). The primary outcome and secondary outcome of the study was to compare the quality of analgesia (verbal rating score) and maternal satisfaction respectively. The Double blind prospective randomized study included 60 parturients of ASA I and II with 37-41 weeks of singleton pregnancy in active labor, cervical dilatation >4 cm, with no obstetrical or medical complication, requesting painless labor, randomized into two groups (30 each) by a computer generated randomized sequence:Group R- received intrathecal 2.5 mg ropivacaine followed by epidural administration of 10 ml 0.125% ropivacaine Group L- received intrathecal 2.5 mg levobupivacaine followed by epidural administration of 10 ml 0.125% levobupivacaine. The primary and secondary outcome of the study was to compare the quality of analgesia and maternal satisfaction respectively. Statistical testing was conducted with the statistical package for social science system version (SPSS) 17.0. Group R had late onset and shorter duration of action with lesser motor blockade, however the results were statistically insignificant. Group L had slightly less total consumption of local anaesthetic and better maternal satisfaction, but was statistically insignificant. Patients in both groups had statistically similar pain scores at various intervals. Both levobupivacaine and ropivacaine are highly effective for labor analgesia using the combined spinal epidural (CSE) technique.

Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

2017 ◽  
Vol 2 (2) ◽  
pp. 73-77
Author(s):  
Malti Agrawal ◽  
Yogesh K Sharma
Keyword(s):  
Side Effects ◽  
Comparative Study ◽  
Randomized Study ◽  
Rapid Onset ◽  
Labor Analgesia ◽  
Singleton Pregnancy ◽  
Double Blind ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

ABSTRACT Introduction Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade. Materials and methods This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test. Results A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups. Conclusion Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination. How to cite this article Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

scholarly journals Nalbuphine versus dexmedetomidine for treatment of combined spinal-epidural post-anesthetic shivering in pregnant women undergoing cesarean section

2019 ◽  
Vol 47 (9) ◽  
pp. 4442-4453 ◽  
Author(s):  
Jing Sun ◽  
Zhao Zheng ◽  
Yi-Lu Li ◽  
Li-Wei Zou ◽  
Ge-Hui Li ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Epidural Anesthesia ◽  
Randomized Study ◽  
Saline Group ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Objective This study aimed to compare the clinical efficacy and side effects of nalbuphine and dexmedetomidine for treatment of combined spinal-epidural anesthetic shivering in women after cesarean section. Methods A total of 120 pregnant women, who underwent elective cesarean section under combined spinal-epidural anesthesia, were enrolled in a double-blind, randomized study. These women were randomized into three groups of 40 pregnant women each to receive either saline (group C), nalbuphine 0.07 mg/kg (group N), or dexmedetomidine 0.5 µg/kg (group D) for treatment of shivering after anesthesia. The main outcome measure was a significant reduction in the time required for shivering after intervention. Results The mean time to cessation of shivering in groups N and D was significantly shorter than that in group C (3.5±2.7 and 4.2±3.7 versus 14.5±1.4 minutes). The success rate of shivering treatment and Observer’s Assessment of Alertness/Sedation scores in groups N and D were significantly higher than those in group C, while the recurrence rate was lower than that in group C. Conclusion Nalbuphine 0.07 mg/kg can be used safely and effectively for shivering in pregnant women under combined spinal-epidural anesthesia.

Ambulatory Combined Spinal-Epidural Analgesia for Labor: Influence of Epinephrine on Bupivacaine-Sufentanil Combination

1997 ◽  
Vol 22 (2) ◽  
pp. 143-149
Author(s):  
Philippe E. Gautier ◽  
François Debry ◽  
Luc Fanard ◽  
Albert Van Steenberge ◽  
Jean-Luc Hody
Keyword(s):  
Motor Block ◽  
Randomized Study ◽  
Sensory Block ◽  
Cervical Dilation ◽  
Double Blind ◽  
Late Side Effect ◽  
Combined Spinal Epidural ◽  
Block Level ◽  
Spinal Epidural ◽  
Late Side

Background and ObjectivesSubarachnoid sufentanil 5 μg during labor is known to have variable results. However, subarachnoid sufentanil 5 μg plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 μg to this mixture.MethodsForty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 μg and bupivacaine 1 mg with or without epinephrine 25 μg. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.ResultsAddition of epinephrine prolonged the duration of analgesia from 103.8 ± 28.2 minutes to 142 ± 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.ConclusionsThis minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 ± 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

DOES A COMBINED SPINAL-EPIDURAL TECHNIQUE IMPROVE THE QUALITY OF SUBSEQUENT EPIDURAL LABOR ANALGESIA? 

2001 ◽  
Vol 94 (1A) ◽  
pp. NA-NA
Author(s):  
J. A. Thomas ◽  
L. Harris ◽  
P. Reiker ◽  
R. D'Angelo
Keyword(s):  
Labor Analgesia ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

scholarly journals Spinal subdural hematoma and subdural anesthesia following combined spinal–epidural anesthesia: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanmei Bi ◽  
Junying Zhou
Keyword(s):  
Epidural Anesthesia ◽  
Subdural Hematoma ◽  
Cauda Equina ◽  
Vital Signs ◽  
Epidural Administration ◽  
Single Shot ◽  
Combined Spinal Epidural ◽  
Spinal Subdural Hematoma ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia. Case presentation A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal. Conclusions All anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.

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