scholarly journals Epidural analgesia in labor in relation to the rate of instrumental deliveries

Author(s):  
Lubna Javed ◽  
Anbrin Salick ◽  
Naheed Jamal Faruqi

Aims & Objectives: To study the effect of epidural analgesia (EA) in labour on the rate of instrumental deliveries Study Design: Clinical Trial / Case Control study. Study Settings: Labour ward of Jinnah Hospital, Lahore during one year period from July 2002 to June 2003. Patients and Methods: One hundred women in labor at term were divided into two equal groups. Group-I comprised of those women who were provided with epidural analgesia while group-II consisted of those women who had labour without the block. The anesthetist provided epidural analgesia using 0.125% bupivacaine and the obstetrician or midwife gave intermittent top-ups. Main Outcome Measures: The main outcome measures were the effect of epidural analgesia on the duration of second stage of labor and the rate of instrumental deliveries. The data was collected on a pre-designed proforma and was analyzed on computer software (SPSS). Ratio and proportions were calculated and Chi-square test was used to check significant association between the groups. P<.05 was considered statistically significant. Results: Gestational age, gravidity, duration of first stage of labour, and fetal outcome were comparable between the two groups. There was prolongation of second stage of labour (P < 0.05). 30% of the parturient in the group with epidural analgesia had second stage of <1 hour while there were 84 % of women in the control group who had second stage of <1 hour. 66% of the women in group I (EA) had duration of second stage of 1-2hours while in group-II 16% of women delivered in the same period. 4% of the women in the study group had second stage of >2hours while there was none (0.0%) who took >2hours in the control group. There was an increased rate of instrumental deliveries in patients with epidural analgesia (P<0.05). 40% of women had instrumental deliveries in the study group as compared to 10 % in the control group. Patient satisfaction was excellent among parturient given EA, 94 % of the parturient being very satisfied. Conclusion: Epidural analgesia along with an experienced anesthetist, a dedicated obstetrician and a trained midwife can convert the painful labour into a less stressful event. Although it prolongs the second stage of labour and increases the rate of instrumental deliveries yet its advantages of pain free labour, better psychological outcome and no significant complications outweigh these drawbacks.

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Haitao Sun ◽  
Jing Li ◽  
Yue Wang ◽  
Xiaoke Ma

Objective. To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods. The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results. No obvious difference in general data among groups ( P > 0.05 ). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher ( P < 0.05 ), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups ( P > 0.05 ). Compared with the control group, the scores of CAS-R of the study group were obviously higher ( P < 0.05 ), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better ( P < 0.05 ). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion. Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients’ perceived control attitude and self-efficacy.


2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S154-S154
Author(s):  
A S Boraik ◽  
M Abdelmonem ◽  
M Shedid ◽  
H M Abd Elaal ◽  
A Elhusseny ◽  
...  

Abstract Introduction/Objective Chronic kidney disease (CKD) is affecting about 14% of the general population. CKD is associated with a decrease in calcium level in the body. In the early stages of (CKD), dialysis may not be needed. The late stages of CKD will require dialysis or a kidney transplant to save a life. Secondary hyperparathyroidism is a crucial disorder in CKD patients. It explains why the illness causes a significant change in bone and mineral metabolism. This study aims to study renal hyperparathyroidism (rHPT) in dialysis patients with late-stage of chronic kidney disease (CKD). Methods/Case Report A total of 55 subjects were enrolled in this study for late-stage dialysis patients from Egypt. Serum creatinine and PTH levels were measured. Among the 55 subjects; 41 subjects (74.5%) were males, 14 subjects (25.5%) were females with a mean age of 52.7 and 34.3 years for males and females, respectively. Subjects were divided into two groups; Study group I consists of 33 dialysis patients; three patients were females (9%) while 30 patients were males (91%), and control group II consists of 22 healthy individuals, 11 subjects were females (50%), and 11 subjects were males (50%). Results (if a Case Study enter NA) In our study, in comparison between two groups as regards blood investigations. The means of creatinine and PTH in the study group I were 8.93 mg/dl and 316.8, while in the control group II were 0.9, and 38.4 respectively. Comparing the two groups shows that mean of Creatinine and PTH in the study group was statistically significantly higher than the control group (p-value less than 0.001). Conclusion In patients with CKD, accurate measurement of (PTH) is critical for treatment decision-making to reduce the risk of bone and cardiovascular diseases. We recommend that patients with diabetes and high blood pressure be aware that they must take their medications consistently to avoid kidney problems.


2021 ◽  
pp. 10-13
Author(s):  
R.Shanthi Malar ◽  
V. Vijayalakshmi ◽  
P. Thenmozhi

BACKGROUND:Pain relief during labour is an important component of modern obstetric care and can be produced by neuraxial, systemic or inhalational analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique.A good labour analgesia should aim at good pain relief during delivery process,at the same time not causing foetal acidosis,ensures safe for both mother and the baby. AIM OF THE STUDY:To study the influence of epidural analgesia on maternal and neonatal outcome MATERIALS AND METHODS:The study was conducted in the depar tment of Obstet r ics and Gynecology,GOVT.Stanley Medical College,Govt.RSRM LYING IN HOSPITAL,CHENNAI over a period of eight months from July 2019 to February 2021. The study was performed in 120 selected subjects. The study subjects were divided based on intervention – labour analgesia into 2 study groups. In this study,change in vital parameters,fetal heart rate,assessment of pain score,Duration of first and second stage of labour,mode of delivery,APGAR score and the need for NICU admission were noted and recorded.Any complications during the course of labour were also recorded. RESULTS:In this study,there was no significant difference in the mean duration of first and second stage of labour in both the study and control groups.The mean Apgar score of babies at one minute was 7.02 and at 5 minutes was 8.07 in the labour analgesia group and showed no significance.Maternal satisfaction for the effect of epidural analgesia,60.00% of the patients of epidural analgesia, the incidence of satisfactory/very satisfactory experience was meaningfully and significantly more in labour analgesia group subjects compared to control group subjects by 30 % with a 2 fold increase. CONCLUSION: As per this study labour analgesia using neuroaxial blockade technique are more likely to encounter increasing maternal satisfaction and good quality labour pain reduction.


2021 ◽  
pp. 55-58
Author(s):  
Rahul Wagh ◽  
Swapnil Sangale ◽  
Nagesh Jambure

Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS, patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures, cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods. Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine, pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if any, in patients undergoing lower limb surgeries. Materials and Methods: After approval from the local ethics committee and with written informed consent from patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients belonging to American Society of Anesthesiologists (ASA)classification I &amp; II, aged between 18-60 years, posted for elective lower limb surgeries, were randomly allocated for the study. Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only. Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex distribution. Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative analgesics. Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic disturbance and better postoperative outcome with/ minimum side effects.


2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
G. K. Pal ◽  
P. Shyma ◽  
S. Habeebullah ◽  
Pravati Pal ◽  
Nivedita Nanda ◽  
...  

Objective. In this study, we have assessed sympathovagal imbalance (SVI) by spectral analysis of heart rate variability (HRV) that contributes to the genesis of early-onset PIH.Methods. Body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and HRV indices such as LFnu, HFnu, LF-HF ratio, mean RR, SDNN and RMSSD were assessed in normal pregnant women (Control group) and pregnant women having risk factors for PIH (Study group) at all the trimesters pregnancy. Retrospectively, those who did not develop PIH (Study group I) were separated from those who developed PIH (Study group II). Study group II was subdivided into early-onset and late-onset PIH. Sympathovagal balance (LF-HF ratio) was correlated with BMI, BHR and BP.Results. LF-HF ratio was significantly high in study group II compared to study group I and control group, and in early-onset PIH group compared to the late-onset category at all the trimesters of pregnancy, which was significantly correlated with BHR and BP. Alteration in HFnu in early-onset category was more prominent than the alteration in LFnu.Conclusion. Though the SVI in PIH is contributed by both sympathetic overactivity and vagal withdrawal, especially in early-onset type, SVI is mainly due to vagal inhibition.


2015 ◽  
Vol 28 (1) ◽  
pp. 70 ◽  
Author(s):  
José Manuel Costa-Martins ◽  
Cláudia Camila Dias ◽  
Marco Pereira ◽  
Jorge Tavares

<p><strong>Background:</strong> Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 μg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 μg.ml-1 sufentanil) on the intervals between boluses and the duration of labor.<br /><strong>Material and Methods:</strong> In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil) and Group II (n = 57; 0.6 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded.<br /><strong>Results:</strong> The ropivacaine dose was greater in Group I (9.5 [7.7-12.7] mg.h-1 vs. 6.1 [5.1-9.8 mg.h-1], p &lt; 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p &lt; 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI [-2.44; -0.36], p = 0.009). The duration of the second stage of labor in Group I was significantly longer<br />than that in Group II (78 min vs. 65 min, p &lt; 0.001).<br /><strong>Conclusions:</strong> Parturients receiving 0.06% ropivacaine exhibited less evidence of cumulative effects and exhibited faster second stage progression than those who received 0.1% ropivacaine.<br /><strong>Keywords:</strong> Analgesia, Obstetrical; Analgesia, Patient-Controlled; Labor Pain; Ropivacaine; Sufentanil.</p>


2014 ◽  
Vol 2 (2) ◽  
pp. 56-62
Author(s):  
Md. Nooruzzaman ◽  
MM Masud Pervez ◽  
Md. Abu Bakar Akan ◽  
M Anisuzzaman ◽  
Md. Nazrul Islam ◽  
...  

Background: Preemptive analgesia, an evolving clinical concept, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain. Pain is inevitable after any surgery. Surgery offers the most promising setting for preemptive analgesia because the timing of noxious stimuli is known.Materials & Methods: This prospective double blind study included 60 children (30 in each group), undergoing major surgery under general anesthesia. Each patient in the study group (Group II) received pre-emptive analgesia (Local anesthesia, per-rectal diclofenac just prior to surgery, per-rectal paracetamol 2 hours prior to surgery) and regular pattern of postoperative pain intervention with per rectal diclofenac and per rectal or oral paracetamol in different phases of postoperative pain management up to 48 hours. On the other hand, each patient of control group (Group I) received pre-emptive analgesia (Local anesthesia & per-rectal diclofenac) regular pattern of postoperative pain intervention with per-rectal diclofenac in different phases of postoperative pain up to 48 hours. The degree of postoperative pain was assessed by universal pain assessment tools (VAS) at defined intervals.Results: Most children in the study group (Group II) has significantly better postoperative pain control with only mild pain at 4th postoperative hours. It is obvious that less pain in Group-II due to synergistic effect of paracetamol and diclofenac. In the control group (Group I) there was persistence of mild pain throughout the observation period i.e. up to 48 postoperative hours. The breakthrough pain occurred more in latter group, two patients needed rescue analgesia. Whereas no patient experienced breakthrough pain requiring rescue analgesia in study group (Group II).Conclusion: Therefore this study concludes that administrations of multimodal pre-emptive analgesia control pain more effectively in children in view of both the degree of pain control and sustainability of pain free state.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19545


2021 ◽  
Vol 66 (5) ◽  
pp. 50-58
Author(s):  
A. Polynovskiy ◽  
D. Kuz'michev ◽  
Z. Mamedli ◽  
Sergey Tkachev ◽  
M. Chernich ◽  
...  

Purpose: To improve the effectiveness of treatment of patients with locally advanced rectal cancer (LARC) stage T3(MRF+)-4N0-2M0 by developing a new strategy of therapy. Material and methods: The study included 414 patients with LARC. Control group I included 89 patients who underwent neoadjuvant CRT 52–56 Gy with capecitabine. Control group II included 160 patients, underwent neoadjuvant CRT 52–56 Gy with capecitabine and oxaliplatin once a week, during the course of RT. Study group III - 165 patients. This group combined neoadjuvant CRT 52–56 Gy with capecitabine and additional consecutive courses of chemotherapy (CT) in the CapOx mode. This group, depending on the variant of chemotherapy, was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating CT (after CRT); subgroup IIIb included 59 patients who underwent "sandwich" treatment. Therapy consists of conducting 1 or 2 courses of induction CT (up to CRT) in the CapOx mode and 1 or 2 courses of consolidating CT in the CapOx mode with an interval of 7 days. In the interval between the courses of drug therapy, prolonged CRT was performed. According to the results of the control examination, further treatment tactics were determined. Results: IComplete therapeutic pathomorphosis in the tumor was significantly more frequently registered in patients in the study group III (17.5 %; p=0.021) compared to the control groups: in I – 8.0 % and II – 8.3 %. In total, relapses in the study were registered in 34 (8.3 %) of 410 patients. A comparative analysis of patients in the control groups (I and II) of treatment did not determine significant differences in the development of relapses (11.4 % vs. 10.8 %, respectively; p=0.884). When analyzing the subgroups (IIIa and IIIb) of the study group, there were also no significant differences in the development of relapses (4.8 % vs. 3.4 %; p=0.676). In the present study, long-term metastases at various times after treatment were diagnosed in 100 (24.4 %) of 410 patients. All metastases occurred at a median follow-up of 20.9 months (4 to 46 months). Metastases were significantly less frequent in patients in group III (18.3 %) compared to group I (31.8 %; p=0.015) and II (26.6 %; p=0.037). There were no significant differences between patients in group I and II (p=0.382). The analysis of the treatment subgroups of the study group (IIIa and IIIb) did not determine significant differences in the development of metastases (19.1 % vs. 17.0 %; p=0.456). The overall five-year survival rate in patients in group III was 90.5 %, in group I – 71.8% and in group II – 78.3%. Five-year relapse-free survival in patients in the study groups was: III – 71.5%, I – 56.9% and II – 65.6%, respectively. Conclusion: The shift in the focus on strengthening the neoadjuvant effect on the tumor and the improvement of approaches to drug therapy regimens allowed to significantly increase the relapse-free survival in this category of patients.


2017 ◽  
Vol 18 (10) ◽  
pp. 911-914
Author(s):  
Shruti Dev ◽  
Mirna Garhnayak ◽  
Angurbala Dhal ◽  
Lokanath Garhnayak ◽  
Aswini K Kar

ABSTRACT Introduction Alginate is a versatile, irreversible hydrocolloid impression material, which is cost-effective and forms an essential component in dental practice. For elevating the hardness of the cast models, hardeners are combined with stone. Hence, we planned the present study to evaluate the impact of altering the time of contact between alginate and stone after various interim periods. Materials and methods The present study included the assessment of impact of time of contact between alginate and stone by the construction of 90 casts using a cylinder model. Two bisecting lines were marked and were named as y and y'. These lines were used for testing the dimensional stability. Using chemically cured acrylic resin, the construction of ten special trays was done. All the impression casts were randomly divided into two study groups, with 45 casts in each group.group I: control group, casts were removed after 60 minutes; group II: study group, casts were removed after 9 hours. A digital caliper was used for measuring the dimensional stability of the cast. All the data were collected and analyzed. Results In the specimens of the control group (group I) and the study group (group II), the mean dimensions from y to y' were found to be 17.54 and 17.95 respectively. The mean reading of hardness in the control group and study group was found to be 0.59 and 0.20 respectively. In groups I and II, the number of specimens showing clarity of two lines (X and X”) was 0 and 5 respectively. Conclusion There was no change in the dimensional stability of the dental stone model when the contact time was increased. Clinical significance Within certain limits, the contact time between alginate and stone can be altered without significantly altering the properties of the cast. How to cite this article Dev S, Kar AK, Garhnayak M, Garhnayak L, Dhal A. Assessment of Influence of Contact Time between Alginate and Type III Dental Stone on Properties of Cast Model: An in vitro Study. J Contemp Dent Pract 2017;18(10):911-914.


2008 ◽  
Vol 15 (01) ◽  
pp. 101-103
Author(s):  
MUHAMMAD ASGHAR KHAN ◽  
BILAL YASIN ◽  
MONA ZAFFAR ◽  
Shafi ur Rehman

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.


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