Intrathecal Labor Analgesia Using Dexmedetomidine: A Viable Alternative to Epidural Analgesia

Abstract Background The dural puncture epidural (DPE) technique is relatively a new technique of labor analgesia and has been advocated with the advantage of faster onset of pain relief. However, there are differences of opinion regarding the efficacy of the DPE technique and the size of the spinal needle to be used for the DPE. Various studies have suggested that DPE can only be done with a larger gauge of a spinal needle; however, recent studies have variable observations. We have compared the conventional lumbar epidural analgesia and DPE using a 27G pencil-point needle to assess the efficacy of DPE and its possible side effects. Results The time to achieve a 50% reduction in VAS was 7.06 ± 0.79 min in group CLE (n = 15) and 5.0 ± 1.06 min in group DPE (n = 15) (difference of two means was 2.06, 95% CI [1.36, 2.75], t = 5.99, p < 0.0001). The time to achieve VAS < 3 in group CLE was 14.93 ± 1.98 min, and in the group DPE, it was 10.13 ± 1.45 min (difference of two means was 4.8, 95% CI [3.52, 6.09], t = 7.55, p < 0.0001). The mode of delivery, APGAR scores, and side effects were comparable (p > 0.05). Conclusions DPE provided faster relief of labor pain than the conventional labor epidural analgesia. There were no added side effects by DPE in conventional lumbar epidural analgesia for labor. A 27G Whitacre pencil-point needle can be used for DPE. Trial registration CTRI, CTRI/2020/08/027060. Registered on 10/08/2020. Trial registered prospectively. CTRI website URL: http://ctri.nic.in

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Education Program Regarding Labor Epidurals Increases Utilization by Hispanic Medicaid Beneficiaries

Anesthesiology ◽

10.1097/aln.0000000000002868 ◽

2019 ◽

Vol 131 (4) ◽

pp. 840-849 ◽

Cited By ~ 6

Author(s):

Brandon M. Togioka ◽

Katherine M. Seligman ◽

Megan K. Werntz ◽

N. David Yanez ◽

Lorna M. Noles ◽

...

Keyword(s):

Epidural Analgesia ◽

Risk Ratio ◽

Educational Program ◽

Hispanic Women ◽

Controlled Trial ◽

Intervention Group ◽

Routine Care ◽

Labor Analgesia ◽

Care Group ◽

Medicaid Beneficiaries

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Hispanic women choose epidural labor analgesia less commonly than non-Hispanic women. This may represent a healthcare disparity related to a language barrier and inadequate opportunities for labor analgesia education. It was hypothesized that a language-concordant, educational program regarding labor epidurals would improve epidural utilization in two independent cohorts of Hispanic and non-Hispanic women. Methods A randomized controlled trial, blinded to anesthesia, nursing, and obstetric providers, was completed at an academic hospital (February 2015 to February 2017). Two cohorts of Medicaid beneficiaries of Hispanic (English- and/or Spanish-speaking) and non-Hispanic ethnicity were enrolled concurrently. The patients were randomized to routine care alone or routine care and an additional educational program comprised of three components: a video show, corresponding pamphlet, and in-person counseling. The primary endpoint was use of epidural labor analgesia. The secondary endpoint was change in response before and after delivery on common misconceptions based on a 12-point epidural questionnaire. Results Hispanic women randomized to the intervention group were 33% more likely to choose epidural analgesia compared to the routine care group (40 of 50 [80%] vs. 30 of 50 [60%]; risk ratio, 1.33 [95% CI, 1.02 to 1.74]; P = 0.029). For the non-Hispanic cohort, no difference was detected in epidural use between the intervention and routine care groups (41 of 50 [82%] vs. 42 of 49 [86%]; risk ratio, 0.96 [95% CI, 0.80 to 1.14]; P = 0.62), but the study was underpowered to determine a result of no difference. Patients assigned to the intervention had a greater improvement in epidural understanding compared with routine care, among both Hispanic (2.26 vs. 0.74, respectively; difference in change from baseline, 1.52 [95% CI, 0.77 to 2.27]; P < 0.001) and non-Hispanic (1.36 vs. 0.33, respectively; difference in change from baseline, 1.03 [95% CI, 0.23 to 1.75]; P = 0.005) cohorts. There were no adverse events during the trial. Conclusions The educational program increased epidural use among Hispanic women. The educational program reduced misconceptions regarding epidural analgesia in both Hispanic and non-Hispanic cohorts.

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Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196045 ◽

2019 ◽

Vol 9 (1) ◽

pp. 342

Author(s):

Aastha Raheja ◽

Krishna Agarwal ◽

Rini Pachori ◽

Gauri Gandhi

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Apgar Score ◽

Controlled Trial ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Study Drug ◽

Visual Analogue Score ◽

Labor Analgesia ◽

Eligibility Criteria

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.

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Epidural Labor Analgesia: Continuous Infusion Versus Patient-Controlled Epidural Analgesia With Background Infusion Versus Without a Background Infusion

Journal of Pain ◽

10.1016/j.jpain.2007.07.002 ◽

2007 ◽

Vol 8 (12) ◽

pp. 970-975 ◽

Cited By ~ 26

Author(s):

Manuel C. Vallejo ◽

Vimala Ramesh ◽

Amy L. Phelps ◽

Neera Sah

Keyword(s):

Epidural Analgesia ◽

Continuous Infusion ◽

Labor Analgesia ◽

Background Infusion

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Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia

Macedonian Medical Review ◽

10.1515/mmr-2017-0017 ◽

2017 ◽

Vol 71 (2) ◽

pp. 99-104

Author(s):

Dafina Karadjova ◽

Mirjana Shosholcheva ◽

Atanas Sivevski ◽

Emilija Ivanov ◽

Ivo Kjaev ◽

...

Keyword(s):

Patient Satisfaction ◽

Epidural Analgesia ◽

Labor Analgesia ◽

Nausea And Vomiting ◽

Pain Patient ◽

Patient Controlled Analgesia ◽

Pain Scores ◽

Significant Difference ◽

Patient Pain ◽

Remifentanil Group

Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.

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REVIEW OF OPIOID PCA FOR LABOUR ANALGESIA

Fetal and Maternal Medicine Review ◽

10.1017/s0965539512000010 ◽

2012 ◽

Vol 23 (1) ◽

pp. 15-31

Author(s):

DAVID HILL ◽

PAUL McMACKIN

Keyword(s):

Epidural Analgesia ◽

Gold Standard ◽

Labour Analgesia ◽

Viable Alternative

The epidural route is currently the gold standard for labour analgesia, although it is not without serious consequences, especially when incorrect placement goes unrecognised. Intravascular, intrathecal and subdural placements have been reported to occur with incidences of 1 in 5000, 1 in 2900 and 1 in 4200 respectively. Until recent years there has not been a viable alternative to epidural analgesia.

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Chronobiology of Subarachnoid Fentanyl for Labor Analgesia

Anesthesiology ◽

10.1097/00000542-200509000-00023 ◽

2005 ◽

Vol 103 (3) ◽

pp. 595-599 ◽

Cited By ~ 18

Author(s):

Peter H. Pan ◽

Sherman Lee ◽

Lynne Harris

Keyword(s):

Epidural Analgesia ◽

Pain Scale ◽

Labor Analgesia ◽

Patient Demographics ◽

Combined Spinal Epidural ◽

Institutional Review ◽

Nulliparous Women ◽

Scale Scores ◽

Administration Time ◽

Spinal Epidural

Background Chronobiology studies the recurrent biologic rhythms that directly affect how an organism interacts with its environment and how its environment affects the organism. The purpose of this study is to determine whether the time of administration influences the analgesic duration of the commonly used subarachnoid fentanyl for labor analgesia. Methods After institutional review board approval and informed consent were obtained, 77 healthy nulliparous women in active labor requesting neuraxial analgesia were assigned to one of two groups, based on the time of combined spinal-epidural analgesia placement: the day group, for the time period from 12:00 to 18:00, and the night group, for the period from 20:00 to 02:00. Combined spinal-epidural analgesia was performed with 20 microg subarachnoid fentanyl. An epidural catheter was inserted but not dosed until patients requested further analgesia. Dynamic data were recorded at 5-min intervals for 20 min initially and then every 15 min. The analgesic duration was defined as the time from subarachnoid fentanyl injection to the time the patient requested further analgesia. Results Seventy evaluable patients completed the study, with 35 per group. Patient demographics, visual analog pain scale scores, and labor characteristics were similar between groups, but the duration (mean +/- SD) for subarachnoid fentanyl labor analgesia was 92 +/- 34 min for the day group and 67 +/- 21 min for the night group (P < 0.001). Conclusions The results indicate that chronobiology of subarachnoid fentanyl plays a significant role of up to 27% difference in labor analgesic duration between the two administration time periods studied. Chronobiology should be incorporated in future comparative studies or analysis of previous studies on subarachnoid fentanyl.

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