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Labour Analgesia

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264 papers 500 to 1000 followers A collection from an obstetric anesthesiologist with an interest in patient centred analgesia and new modalities
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
Jeanette R Bauchat, Carolyn F Weiniger, Pervez Sultan, Ashraf S Habib, Kazuo Ando, John J Kowalczyk, Rie Kato, Ronald B George, Craig M Palmer, Brendan Carvalho
The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery...
May 9, 2019: Anesthesia and Analgesia
Hon Sen Tan, Ban Leong Sng, Alex Tiong Heng Sia
PURPOSE OF REVIEW: Neuraxial techniques are the current gold standard for labour analgesia, but are associated with up to 25% incidence of breakthrough pain. In this review, we aim to update clinicians on the latest research pertaining to the optimization of neuraxial labour analgesia. RECENT FINDINGS: Attempts to improve the efficacy and reliability of epidural analgesia while minimizing adverse effects have resulted in the rising popularity of combined spinal epidural and the dural puncture epidural (DPE)...
June 2019: Current Opinion in Anaesthesiology
J Murphy, J Vaughn, K Gelber, A Geller, M Zakowski
BACKGROUND: With over 90% of parturients searching the internet for health information, the quality of information is important. Web-based patient education materials (PEMs) related to labor analgesia are frequently of low readability. This study compares the readability, content, quality and accuracy of labor analgesia-related PEMs from relevant healthcare society websites and the top internet search results. METHODS: The first ten PEMs from Google searches for "labor epidural" and "labor pain relief" were compared with PEMs from North American and United Kingdom anesthesiology, obstetric and medical society websites...
January 8, 2019: International Journal of Obstetric Anesthesia
Mike O'Connor
For most prospective mothers, pain in childbirth is their greatest fear. However, intolerable labour pain should no longer be accepted by the health professions. Without adequate pain control in labour fetal damage can be significant. Moreover, if relief from pain is a fundamental human right then surely standards of good obstetric care should include a definition of adequate pain relief in labour and obstetricians should pay due attention to alleviating that pain. At present actions in tort focus on poor medical management of injuries or diseases...
April 2019: Journal of Law and Medicine
André P Boezaart, Alberto Prats-Galino, Olga C Nin, Anna Carrera, José Barberán, José M Escobar, Miguel A Reina
OBJECTIVE: Our aim was to study the posterior lumbar epidural space with 3D reconstructions of magnetic resonance images (MRIs) and to compare and validate the findings with targeted anatomic microdissections. DESIGN: We performed 3D reconstructions of high-resolution MRIs from seven patients and normal-resolution MRIs commonly used in clinical practice from 196 other random patients. We then dissected and photographed the lumbar spine areas of four fresh cadavers...
March 28, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Marcio A Souza, Jose P S Guida, Jose G Cecatti, João P Souza, Ahmet M Gulmezoglu, Ana P Betran, Maria R Torloni, Joshua P Vogel, Maria L Costa
Aim: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery...
2019: BioMed Research International
Jennifer L Wagner, Robert S White, Elizabeth A Mauer, Kane O Pryor, Klaus Kjaer
BACKGROUND: Neuraxial analgesia is preferred over general anesthesia for cesarean delivery (CD), particularly in the presence of a labor epidural catheter. We hypothesize that care by a non-obstetric anesthesiologist as compared to care by an obstetric anesthesiologist is associated with a higher risk for use of general anesthesia for CD for patients with a preexisting labor epidural catheter. METHODS: To determine whether fellowship status of the covering anesthesiologist was a risk factor for general anesthesia, we retrospectively investigated the rate of general anesthesia use in patients with epidural catheters placed for labor analgesia who subsequently required CD...
March 21, 2019: Acta Anaesthesiologica Scandinavica
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
March 2019: Obstetrics and Gynecology
Mary Angela O'Neal
Neurologists are often consulted to see women postpartum who are having difficulties involving the lower extremities; weakness, numbness and pain. Many of these women have received labour analgesia. Often, there is limited understanding by the neurologist of how these procedures are performed, why a neuraxial technique is chosen and their potential complications. This case-based review will explain the differences in the neuraxial procedures: epidural, spinal and combined spinal epidural; their advantages and disadvantages, why one technique might be chosen over another, contraindications as well as procedural risks...
February 12, 2019: Practical Neurology
Yaniv Zipori, Oren Grunwald, Yuval Ginsberg, Ron Beloosesky, Zeev Weiner
BACKGROUND: A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery such as uterine rupture, adhesive placental disorders, hysterectomy and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor...
October 25, 2018: American Journal of Obstetrics and Gynecology
Alexander J Butwick, Jason Bentley, Cynthia A Wong, Jonathan M Snowden, Eric Sun, Nan Guo
Importance: Neuraxial labor analgesia is recognized as the most effective method of providing pain relief during labor. Little is known about variation in the rates of neuraxial analgesia across US states. Identifying the presence and extent of variation may provide insights into practice variation and may indicate where access to neuraxial analgesia is inadequate. Objective: To test the hypothesis that variation exists in neuraxial labor analgesia use among US states...
December 7, 2018: JAMA network open
Danielle M Gleeson, Alison Craswell, Christian M Jones
BACKGROUND: Social support is essential in both the transition to motherhood and maternal role development. With diminishing access to traditional communities of motherhood wisdom, women struggle to access this information in their tangible worlds. AIM: This paper presents a review of the research literature investigating childbearing women's use of social networking sites related to pregnancy and parenting and how these may influence women's experiences of the childbearing period...
December 31, 2018: Women and Birth: Journal of the Australian College of Midwives
C Luke Dixon, Luis Monsivais, Petra Chamseddine, Gayle Olson, Luis D Pacheco, George R Saade, Maged M Costantine
OBJECTIVE:  To assess whether distraction using music and/or video games influences timing of analgesia request and improves pain outcomes in women undergoing labor induction. STUDY DESIGN:  A total of 219 pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to distraction with music and video games via iPod ( n  = 109) or no iPod ( n  = 110). The primary outcome was the time from FB placement to request for pain medication...
January 4, 2019: American Journal of Perinatology
S Ciechanowicz, T Setty, E Robson, C Sathasivam, M Chazapis, J Dick, B Carvalho, P Sultan
BACKGROUND: Whilst validated quality-of-recovery (QoR) tools exist for general surgery, there is no specific obstetric equivalent. We aimed to develop and evaluate a modified QoR score after elective Caesarean delivery. METHODS: Twenty-two obstetric specific items were selected following review and modification of the QoR-40 survey by 16 experts and interviews with 50 stakeholders. Item selection was based on relevance to Caesarean delivery and endorsement by >66% of stakeholders...
January 2019: British Journal of Anaesthesia
T Malik, O Malas, A Thompson
BACKGROUND: Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. METHODS: One-hundred parturients requesting epidural analgesia were randomly assigned to receive ultrasound-guided L5-S1 epidural catheter placement (experimental group) or non-ultrasound-guided higher lumbar interspace placement (control group)...
November 20, 2018: International Journal of Obstetric Anesthesia
A A Melber
No abstract text is available yet for this article.
March 2019: Anaesthesia
Sana Amjad, Isaiah MacDonald, Thane Chambers, Alvaro Osornio-Vargas, Sujata Chandra, Don Voaklander, Maria B Ospina
BACKGROUND: Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers. METHODS: Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes...
December 5, 2018: Paediatric and Perinatal Epidemiology
J B Bavaro, J L Mendoza, R J McCarthy, P Toledo, J R Bauchat
BACKGROUND: Early maternal skin-to-skin contact confers numerous benefits to the newborn, but maternal sedation during cesarean delivery could have safety implications for early skin-to-skin contact in the operating room. We compared patient-reported and observer-assessed levels of sedation during unscheduled and scheduled cesarean deliveries. METHODS: Laboring women undergoing unscheduled cesarean delivery with epidural anesthesia, and scheduled cesarean delivery with spinal anesthesia were enrolled...
August 2016: International Journal of Obstetric Anesthesia
Mary McCauley, Valentina Actis Danna, Dorah Mrema, Nynke van den Broek
BACKGROUND: Most women experience pain during labour and after childbirth. There are various options, both pharmacological and non-pharmacological, available to help women cope with and relieve pain during labour and after childbirth. In low resource settings, women often do not have access to effective pain relief. Healthcare providers have a duty of care to support women and improve quality of care. We investigated the knowledge and attitudes of healthcare providers regarding the provision of pain relief options in a hospital in Moshi, Tanzania...
November 14, 2018: BMC Pregnancy and Childbirth
K W Arendt, K J Lindley
Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology...
September 27, 2018: International Journal of Obstetric Anesthesia
2018-11-15 00:45:03
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