RESUMO

BACKGROUND: Studies have shown that the ideal dose of epidural dexmedetomidine is 0.4 µg mL-1 for epidural labor analgesia. However, the appropriate dose of ropivacaine when combined with 0.4 µg mL-1 of dexmedetomidine for epidural labor analgesia is still unknown. Therefore, we aimed to determine the dose-response of ropivacaine when using 0.4 µg mL-1 of dexmedetomidine as epidural adjuvant for labor analgesia. METHODS: One hundred of nulliparous singleton pregnant patients were randomized allocated into 1 of 5 groups with epidural ropivacaine concentration of 0.05%, 0.0625%, 0.075%, 0.0875%, and 0.1%. Labor analgesia was initialed with 12 mL of the mixed study solution. Effective analgesia was defined as a visual analogue scale <10 mm 30 minutes after the initial epidural bolus. The EC50 and EC95 for epidural ropivacaine was calculated by probit regression. RESULTS: Ninety-three of parturients were involved into the final analysis. Totals of 63.2% (12/19), 73.7% (14/19), 88.9% (16/18), 94.7% (18/19), and 100% (18/18) of parturients in group 0.05, 0.0625, 0.075, 0.0875, and 0.1 received effective epidural labor analgesia. The calculated EC50 and EC95 of epidural ropivacaine were 0.046% (95% CI 0.028-0.054%) and 0.086% (95% CI 0.074-0.137%), respectively. CONCLUSIONS: Under the condition of the study, a bolus of 12 mL ropivacaine 0.086% and dexmedetomidine 0.4 µg mL-1 could afford 95% of nulliparous singleton pregnant patients without suffering labor pain after a test dose of lidocaine 45 mg.

Assuntos

Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais , Dexmedetomidina , Relação Dose-Resposta a Droga , Ropivacaina , Humanos , Feminino , Ropivacaina/administração & dosagem , Gravidez , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Adulto , Analgesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Estudos Prospectivos , Analgesia Obstétrica/métodos , Analgésicos não Narcóticos/administração & dosagem , Medição da Dor , Dor do Parto/tratamento farmacológico , Adulto Jovem

RESUMO

Labor epidural analgesia (LEA) is associated with increased maternal body temperature; however, the responsible mechanism is unknown. Recent studies suggest that changes in EA affect the incidence of fever and that epidural sufentanil supplementation enhances analgesia and reduces the amount of local anesthetic. The aim of this study was to evaluate the effect of different concentrations of sufentanil combined with ropivacaine on intrapartum fever during delivery. We performed a retrospective study comparing maternal fever rates in patients receiving labor analgesia between December 2018 and January 2019. Each patient receiving different concentrations of sufentanil in their EA received either proposal H (0.08% ropivacaine + 0.4 µg/mL sufentanil) or proposal L (0.08% ropivacaine + 0.2 µg/mL sufentanil), with the same nulliparous status. The primary outcome of this study was the incidence of intrapartum maternal fever, which was defined as any temperature ≥ 38°C during labor using Fisher exact test. Secondary outcome measures included visual analog scale (VAS) pain scores, birth events, and neonatal outcomes. We observed a perinatal fever incidence rate of 11.7% in the group receiving proposal L, while the incidence rate was 19.8% in the group receiving proposal H (P = .001). Five hours after administration, the average body temperature of the puerpera decreased significantly in the proposal L group compared with proposal H group. In addition, treatment with 0.2 µg/mL sufentanil provided satisfactory pain relief during labor, shortened the first stage of labor and total labor time, reduced oxytocin use, and had no significant adverse effects on neonatal outcomes. EA may increase the risk of intrapartum epidural-associated fever. Compared with the 0.4 µg/mL sufentanil group, the 0.2 µg/mL sufentanil group can provide better analgesia and improve maternal fever. These retrospective results highlighted the importance of prospective and mechanistic studies of maternal fever associated with intraspinal analgesia.

Assuntos

Analgesia Epidural , Anestésicos Locais , Febre , Ropivacaina , Sufentanil , Humanos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico , Feminino , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Gravidez , Estudos Retrospectivos , Adulto , Febre/epidemiologia , Febre/prevenção & controle , Analgesia Epidural/métodos , Analgesia Epidural/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Trabalho de Parto/efeitos dos fármacos , Medição da Dor , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Incidência

RESUMO

AIMS: This study aims to investigate the clinical practice of physicians working in obstetric setting toward postoperative nausea and vomiting (PONV) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia. METHODS: We conducted this online survey to all active members of the Japan Society of Obstetric Anesthesiology and Perinatology (JSOAP), where leads academic society in obstetric anesthesia in Japan. The questionnaire was developed using the Delphi method. The survey included questions about routine practices for PONV prevention, the use of neuraxial opioids, optimal practices, and perceived obstacles. The email sent three times every 2 weeks as a reminder. RESULTS: A total of 1046 e-mails were sent, and 307 JSOAP members responded to the survey (29.3%). More than half of responders (62.7%) used neuraxial opioids with intrathecal morphine being the most frequent. They had a higher rate of multimodal PONV prophylaxis compared with who did not use neuraxial opioids for postoperative analgesia (19.9% vs 6.7%). Metoclopramide was the commonest medication for PONV prevention, and there was a significant difference in the use of 5-hydroxytryptamine receptor antagonists (19.9% vs. 8.6%, p = 0.012). We observed that 80% of physicians reported the routine administration of prophylaxis for PONV for CD. Among these, 20% indicated the use of two or more agents. Conversely, in the cohort not administering neuraxial opioids, only 6.7% reported the use of two or more agents. CONCLUSION: The online survey showed that the physicians using neuraxial opioids for CD had a higher proportion of multimodal PONV management involving two or more agents.

Assuntos

Cesárea , Náusea e Vômito Pós-Operatórios , Humanos , Feminino , Cesárea/efeitos adversos , Japão , Estudos Transversais , Gravidez , Náusea e Vômito Pós-Operatórios/prevenção & controle , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/etiologia , Adulto , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Antieméticos/administração & dosagem , Antieméticos/uso terapêutico , Analgesia Obstétrica/métodos , Analgesia Obstétrica/estatística & dados numéricos

RESUMO

Importance: Epidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes such as hypoxic-ischemic encephalopathy (HIE). Objective: To determine whether epidural analgesia is associated with increased risk of HIE after adjusting for the birthing person's maximal temperature before epidural placement and for the propensity to get an epidural. Design, Setting, and Participants: This retrospective, population-based cohort study was conducted at 15 Kaiser Permanente Northern California hospitals. Participants included singleton neonates born at 35 weeks' or later gestational age between 2012 and 2019. Elective cesarean deliveries and deliveries within 2 hours of hospital admission were excluded. Data analysis was performed from November 2022 to June 2024. Exposure: The primary exposure was epidural analgesia during labor. Main Outcomes and Measures: The primary outcome was HIE, defined as the presence of both neonatal acidosis (ie, pH <7 or base deficit ≥10) and encephalopathy. The presence and timing of epidural analgesia and demographic, pregnancy, and labor characteristics were extracted from electronic medical records. A propensity score for receiving epidural analgesia was created including demographic variables and comorbidities predating epidural placement. Logistic regression was used to evaluate the association between epidural analgesia and HIE, adjusting for maximal birthing parent's temperature before epidural placement and the propensity for receiving an epidural. Results: Among 233 056 infants born at 35 weeks' or later gestational age by vaginal or unplanned cesarean delivery after at least 2 hours of in-hospital labor, 177 603 (76%) were exposed to epidural analgesia and 439 (0.19%) had HIE. On unadjusted analysis, epidural analgesia was associated with an increased risk of maximal temperature greater than 38 °C during labor (risk ratio [RR], 8.58; 95% CI, 8.06-9.14). Each degree increase in maximal temperature during labor was associated with nearly triple the odds of HIE (odds ratio [OR], 2.82; 95% CI, 2.51-3.17). However, there was no significant association between epidural analgesia and the risk of HIE either on crude (RR, 1.21; 95% CI, 0.96-1.53) or adjusted (adjusted OR, 0.93; 95% CI, 0.73-1.17) analyses. Conclusions and Relevance: In this cohort study including more than 230 000 parent-infant dyads, epidural analgesia was associated with increased maximal temperature during labor, a known risk factor for HIE. However, epidural analgesia was not associated with increased odds of HIE.

Assuntos

Analgesia Epidural , Hipóxia-Isquemia Encefálica , Humanos , Analgesia Epidural/efeitos adversos , Analgesia Epidural/estatística & dados numéricos , Feminino , Hipóxia-Isquemia Encefálica/epidemiologia , Gravidez , Recém-Nascido , Estudos Retrospectivos , Adulto , California/epidemiologia , Masculino , Trabalho de Parto/fisiologia , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/estatística & dados numéricos , Analgesia Obstétrica/métodos , Estudos de Coortes

RESUMO

BACKGROUND: Labor pain is the nastiest conceivable pain women are involved in during labor and delivery. In this way, the end of labor pain is frequently outlined by myths and equivocalness. Hence, giving a compelling absence of pain in labor remained a challenge specifically in developing countries including Ethiopia. OBJECTIVES: This systematic review and meta-analysis aimed to explore the pooled prevalence of labor analgesia and associated factors to pregnant women in Ethiopia. DESIGN: A systematic review and meta-analysis were utilized in agreement with the Preferred Reporting Items for Systematic Reviews. DATA SOURCES: PubMed/Medline, SCOPUS, EMBASE, Web of Science, Google Scholars, and the Cochrane Library and supplemented it with manual were deliberately looked at until January 1-30, 2024. METHODS: Two authors independently extricated all principal information utilizing standardized data extraction designs, and the analysis was done utilizing STATA version 17. Heterogeneity over the studies was evaluated utilizing I2 measurement. The funnel plot and Egger's weighted regression tests were utilized to assess subjective and objective publication biases respectively. Also, the pooled effect of labor pain management and the associations were evaluated utilizing a random-effects model. RESULTS: The general pooled prevalence of labor analgesia in the present study was 23.3% with a (95% confidence interval (CI): 13.5, 33.1). Maternal age (odds ratio (OR): 1.91; 95% CI: 1.11, 2.77), parity of the mother (OR: 0.28; 95% CI: 0.06, 0.63), history of pregnancy misfortune (OR: 0.12; 95% CI: 0.11, 0.36), length of labor (OR: 2.09; 95% CI: 1.06, 3.13), and awareness about labor analgesia (OR: 1.91; 95% CI: 0.34, 3.49) were significantly related with labor analgesia among pregnant women in Ethiopia. CONCLUSIONS: The generally pooled prevalence of labor analgesia among pregnant women in Ethiopia was low. Maternal age, parity of the mother, history of pregnancy loss, length of labor, and awareness of labor analgesia were factors influencing labor analgesia among pregnant women in Ethiopia. This finding proposes exceptional consideration to make laboring mothers free of pain by scaling up the strategies and utilizing labor pain administration in a way that universally recognized standards are met. REGISTRATION NUMBER: PROSPERO CRD: 42024525636.

Assuntos

Dor do Parto , Manejo da Dor , Humanos , Gravidez , Feminino , Etiópia/epidemiologia , Dor do Parto/tratamento farmacológico , Manejo da Dor/métodos , Gestantes , Analgesia Obstétrica/estatística & dados numéricos , Trabalho de Parto , Prevalência , Adulto

RESUMO

Shortening analgesic onset has been researched and it has been documented that prewarming epidural medications to body temperature (37°C) prior to administration increases medication efficacy. Our double-blind randomized controlled trial was designed to investigate if a lower degree of prewarming in providers' pockets could achieve similar results without the need of a bedside incubator. A total of 136 parturients were randomized into either the pocket-warmed group or the room temperature group to receive 10 mL of 0.125% bupivacaine with 2 µg/mL fentanyl epidural bolus at either the 27.8 ±1.7°C or 22.1 ±1.0°C temperatures, respectively. Primary outcome, time to analgesic onset (verbal rating scale pain score ≤ 3) was recorded in 0-, 5-, 10-, 15-, 20-, 30-, and 60-minutes intervals. It was observed that the pocket-warming group (n = 64) and room temperature group (n = 72) had no significant difference of analgesic onset time (median 8 vs. 6.2 minutes; p = 0.322). The incidence of adverse events such as hypotension, fever (≥ 38°C), nausea, vomiting, and number of top-off epidural boluses, as well as patient satisfaction rates and mode of delivery, were not significantly different between the groups as well. Further research is warranted to confirm these findings and explore the impact of different temperatures on analgesic onset time as well as the logistical issues associated with their clinical implementations.

Assuntos

Analgesia Epidural , Bupivacaína , Fentanila , Humanos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Analgesia Epidural/métodos , Bupivacaína/administração & dosagem , Adulto , Método Duplo-Cego , Gravidez , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Anestésicos Locais/administração & dosagem , Adulto Jovem

RESUMO

BACKGROUND: It was reported that either shorter programmed intermittent epidural bolus (PIEB) intervals or high-speed bolus can produce more extensive epidural spread. We hypothesized that a combination of shortened time interval and increased speed of epidural bolus might further improve analgesic effect and therefore reduce the hourly volume for epidural labour analgesia. METHODS: This double-blind dose-finding study used a biased coin up-and-down sequential allocation method to determine the 90% effective bolus volume of ropivacaine combined with sufentanil while using the push pump at a rate of 400 mL/hr and interval of 30 min to provide effective analgesia without breakthrough pain. We used 0.1% ropivacaine with 0.4 µg/mL sufentanil, with bolus volumes ranging from 3 to 6 mL. The first patient was assigned a volume of 3 mL, and the remaining volumes were assigned according to the biased coin-up-and-down method. RESULTS: The estimated 90% effective volume (EV90) of ropivacaine combined with sufentanil for epidural labour analgesia at a time interval of 30 min was 4.88 mL (95% confidence interval 4.83-5.38). CONCLUSIONS: The optimum bolus volume of ropivacaine with sufentanil while using push pump at a time interval of 30 min is approximately 5 mL. It could probably further reduce the hourly bolus volume for epidural labour analgesia.

Assuntos

Amidas , Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais , Ropivacaina , Sufentanil , Humanos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Método Duplo-Cego , Feminino , Analgesia Epidural/métodos , Gravidez , Adulto , Anestésicos Locais/administração & dosagem , Analgesia Obstétrica/métodos , Amidas/administração & dosagem , Analgésicos Opioides/administração & dosagem , Relação Dose-Resposta a Droga , Fatores de Tempo , Adulto Jovem

RESUMO

ChatGPT4 is a leading large language model (LLM) chatbot released by OpenAI in 2023. ChatGPT4 can respond to free-text queries, answer questions and make suggestions regarding virtually any topic. ChatGPT4 has successfully answered anesthesia and even obstetric anesthesia knowledge-based questions with reasonable accuracy. However, ChatGPT4 has yet to be challenged in obstetric anesthesia clinical decision-making. STUDY OBJECTIVE: In this study, we evaluated the performance of ChatGPT4 in the management of clinical labor analgesia scenarios compared to expert obstetric anesthesiologists. INTERVENTION: Eight clinical questions with progressively increasing medical complexity were posed to ChatGPT4. MEASUREMENTS: The ChatGPT4 responses were rated by seven expert obstetric anesthesiologists based on safety, accuracy and completeness of each response using a five-point Likert rating scale. MAIN RESULTS: ChatGPT4 was deemed safe in 73% of responses to the presented obstetric anesthesia clinical scenarios (27% of responses were deemed unsafe). None of the ChatGPT4 responses were unanimously deemed to be safe by all seven expert obstetric anesthesiologists. Moreover, ChatGPT4 responses were overall partly accurate (score 4 out of 5) and somewhat incomplete (score 3.5 out of 5). CONCLUSIONS: In summary, approximately one quarter of all responses by ChatGPT4 were deemed unsafe by expert obstetric anesthesiologists. These findings may suggest the need for more fine-tuning and training of LLMs such as ChatGPT4 specifically for clinical decision making in obstetric anesthesia or other specialized medical fields. These LLMs may come to play an important future role in assisting obstetric anesthesiologists in clinical decision making and enhancing overall patient care.

Assuntos

Analgesia Obstétrica , Dor do Parto , Aprendizado de Máquina , Manejo da Dor , Feminino , Analgesia Obstétrica/métodos , Dor do Parto/terapia , Manejo da Dor/métodos , Humanos

RESUMO

STUDY OBJECTIVE: Nitrous oxide affects memory and recall. We aimed to determine if using nitrous oxide during labor affected patients' ability to learn and recall the risks and benefits of neuraxial analgesia. DESIGN: Single-center, prospective cohort study. SETTING: Labor and delivery unit in a large academic medical center. PATIENTS: Nulliparous patients with spontaneous or planned induction of labor. INTERVENTIONS: Parturients chose whether to use nitrous oxide during labor. At the discussion for epidural consent, 4 risks were described: headache, infection, nerve damage, bleeding. MEASUREMENTS: Labor pain score, time from nitrous oxide discontinuation, and cervical dilation were documented at the discussion of epidural risks. Patients were assessed for unprompted recall and prompted recall of epidural risks on postpartum day 1 and unprompted recall at postpartum week 6. The number and proportion of patients who indicated each true risk (unprompted and prompted recall) or distractor (prompted recall only) were summarized by treatment group and results compared using Pearson χ2 tests. MAIN RESULTS: Of the 403 enrolled patients, 294 (73%) did not use nitrous oxide, and 109 (27%) did. The 2 groups were similar except women who used nitrous oxide were more likely to be cared for by midwives and had higher pain scores at their epidural request. Scores for unprompted or prompted recall of epidural risks were not different between women who received or did not receive nitrous oxide. All 4 risks were recalled unprompted by only 3% in the nitrous oxide group and by 6% in the group not receiving nitrous oxide (P = .18). CONCLUSIONS: The use of nitrous oxide for labor analgesia does not adversely influence a parturient's ability to recall the risks of epidural placement. Patients who receive nitrous oxide for labor analgesia should be considered eligible to provide consent for subsequent procedures.

Assuntos

Analgesia Epidural , Analgesia Obstétrica , Rememoração Mental , Óxido Nitroso , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/administração & dosagem , Feminino , Gravidez , Estudos Prospectivos , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Rememoração Mental/efeitos dos fármacos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Medição da Dor/estatística & dados numéricos , Trabalho de Parto/efeitos dos fármacos , Medição de Risco

Assuntos

Analgesia Obstétrica , Humanos , Estudos Prospectivos , Feminino , Gravidez , Analgesia Obstétrica/métodos , Temperatura Baixa , Analgesia Epidural/métodos , Adulto , Bloqueio Nervoso/métodos

RESUMO

BACKGROUND: Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome. METHODS: This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR. RESULTS: This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123-0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289-6.552, p = 0.011). CONCLUSIONS: Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.

Assuntos

Analgesia Epidural , Analgesia Obstétrica , Analgésicos Opioides , Anestesia Epidural , Retenção Urinária , Humanos , Retenção Urinária/etiologia , Feminino , Analgésicos Opioides/administração & dosagem , Gravidez , Estudos Retrospectivos , Estudos de Casos e Controles , Adulto , Fatores de Risco , Transtornos Puerperais/etiologia

Assuntos

Analgesia Obstétrica , Óxido Nitroso , Humanos , Gravidez , Óxido Nitroso/efeitos adversos , Óxido Nitroso/administração & dosagem , Feminino , Recém-Nascido , Adulto

RESUMO

BACKGROUND: The use of hypnosis as a means of pain management during labour is becoming increasingly popular. While recent reviews have reported on pain perception, relaxation and other psychological benefits the impact of hypnosis on the use of pharmacological analgesia use has not been specifically examined. QUESTION: For women in labour at term, does antenatal hypnosis instruction compared to no instruction result in decreased use of pharmacological analgesia and influence maternal and infant birth outcomes. METHODS: Databases such as PubMed, CINAHL, Cochrane Central Register of Controlled Trials and Embase were searched with dates ranging from 1947-2024. We included randomised controlled trials (RCTs) that compared antenatal hypnosis training to no hypnosis control groups, published in English and reported on pharmacological analgesia use. The Cochrane's Risk of Bias 2 for RCTs was used to assess design quality. Study selection, quality assessment, data extraction and analysis were undertaken by two independent researchers. FINDINGS: Six RCTs met the inclusion criteria (n=2937). The use of hypnosis did not result in a significant reduction in the risk of epidural use (RR. 0.79 95% CI 0.39-1.61) or other forms of pharmacological analgesia. Factors such as blinding of care providers to the participants allocated group may have reduced the chances of successful use of hypnosis. Variations in the presentation of hypnosis between studies may also impact on outcomes. DISCUSSION AND CONCLUSION: This review reports no effect on the use of pharmacological analgesia in women trained in hypnosis antenatally compared with those who were not. Our review does highlight several RCT design characteristics that could impact on the measurement and analysis of the use and efficacy of hypnosis.

Assuntos

Hipnose , Feminino , Humanos , Gravidez , Analgesia Obstétrica/métodos , Analgesia Obstétrica/estatística & dados numéricos , Hipnose/métodos , Dor do Parto/tratamento farmacológico , Dor do Parto/terapia , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Trabalho de Parto/efeitos dos fármacos , Manejo da Dor/métodos

Assuntos

Proficiência Limitada em Inglês , Medição da Dor , Humanos , Feminino , Medição da Dor/métodos , Gravidez , Adulto , Analgesia Obstétrica/métodos , Trabalho de Parto

RESUMO

PURPOSE: Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia. METHODS: This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed. RESULTS: Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level. CONCLUSION: Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia. CLINICAL TRIAL NUMBER AND REGISTRY: Clinicaltrials.gov (ChiCTR2100051809).

Assuntos

Analgesia Epidural , Analgesia Obstétrica , Raquianestesia , Dor do Parto , Medição da Dor , Humanos , Feminino , Gravidez , Estudos Prospectivos , Adulto , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Dor do Parto/tratamento farmacológico , Raquianestesia/métodos , Medição da Dor/métodos , Medição da Dor/efeitos dos fármacos , Trabalho de Parto/efeitos dos fármacos , Adulto Jovem , Estudos de Coortes , Satisfação do Paciente , Resultado do Tratamento , Analgésicos/administração & dosagem

RESUMO

OBJECTIVE: Epidural analgesia could increase the risk of maternal fever during labor, and the potential mechanisms involved inflammation. Neutrophil-to-lymphocyte ratio (NLR) was a sensitive inflammatory composite indicator and related to adverse outcomes in parturients. This study aimed to investigate the association between NLR levels and epidural related maternal fever (ERMF). METHODS: This prospective cohort study included 614 parturients who underwent epidural analgesia at the Women's Hospital School of Medicine Zhejiang University from November 2021 to May 2023. NLR level was calculated before epidural analgesia for women. The outcome was ERMF. Univariate and multivariate logistic regression models were utilized to explore the association between NLR level and ERMF. And the association was further investigated in subgroups of age, body mass index (BMI) before pregnancy, and parity of delivery. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Totally, 614 parturients, of whom 171 (27.85%) had ERMF. High NLR level was associated with higher incidence of ERMF (OR = 2.70, 95% CI: 1.58-4.69). Parturients with ERMF had higher proportion of postpartum hemorrhage, longer labor times, and other adverse outcomes in parturients. The association also observed in subgroups of age <35 years old (OR = 2.74, 95% CI: 1.55-4.29), BMI <24 kg/m2 before pregnancy (OR = 2.32, 95% CI: 1.32-4.13), BMI ≥24 kg/m2 before pregnancy (OR = 38.28, 95%CI: 3.67-854.66), primipara (OR = 2.26, 95% CI:1.27-4.04), and multipara (OR = 30.60, 95% CI: 3.73-734.03). CONCLUSION: High NLR levels were associated with ERMF in women. It indicated that physicians may measure NLR levels as a regular measurement, which may beneficial for pregnancy outcomes.

Assuntos

Analgesia Epidural , Febre , Linfócitos , Neutrófilos , Humanos , Feminino , Gravidez , Adulto , Estudos Prospectivos , Analgesia Epidural/estatística & dados numéricos , Analgesia Epidural/efeitos adversos , China/epidemiologia , Febre/epidemiologia , Febre/sangue , Febre/etiologia , Adulto Jovem , Analgesia Obstétrica/estatística & dados numéricos , Analgesia Obstétrica/efeitos adversos , População do Leste Asiático

Assuntos

Analgesia Obstétrica , Negro ou Afro-Americano , Racismo Sistêmico , Adulto , Feminino , Humanos , Gravidez , Analgesia Epidural , Estados Unidos

RESUMO

BACKGROUND: Labor pain is uniquely experienced and described by the woman giving birth, and it is often considered one of the most excruciating experiences for many women. This study aimed to evaluate factors associated with the willingness to receive labor analgesia among women attending the antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia in 2022. METHODS: An institution-based, cross-sectional study was conducted from January to March 2022. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data was entered in EpiData 4.2 and exported to SPSS version 20 for analysis. Both Bivariable and multivariable logistic regressions were conducted to determine factors associated with pregnant women's willingness to choose labor analgesia. Crude odds ratio (COR) and adjusted odds ratio (AOR) were computed to assess the association between variables. RESULTS: A total of 398 pregnant women have participated in the study with a response rate of 94%. Nearly 30%, (29.4%) of the pregnant women had a willingness to practice labor pain management. Being a housewife (AOR: 8.35, 95% CI: 2.07, 33.63). Women who live in urban (AOR: 2.60, 95% CI: 1.29, 5.29). Having had awareness about labor analgesia (AOR: 1.70, 95% CI: 1.00, 2.60) and the short duration of labor time (AOR: 1.84, 95% CI: 1.15, 2.96) were statistically significant with a willingness to practice labor analgesia. CONCLUSION: We conclude that the willingness of pregnant mothers' toward obstetric analgesia practice was low in the study area. Being a housewife, urban residence, awareness about labor analgesia, and short duration of labor were statistically significant with the willingness of the mothers to practice labor analgesia. To increase willingness to use labor analgesia, authorities should prioritize delivering health education on pain management choices to address concerns and promote effective methods and practices.

Assuntos

Analgesia Obstétrica , Dor do Parto , Cuidado Pré-Natal , Humanos , Feminino , Gravidez , Etiópia , Estudos Transversais , Adulto , Analgesia Obstétrica/psicologia , Analgesia Obstétrica/estatística & dados numéricos , Adulto Jovem , Cuidado Pré-Natal/psicologia , Dor do Parto/psicologia , Dor do Parto/terapia , Hospitais Gerais , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Gestantes/psicologia , Adolescente

RESUMO

PURPOSE: To compare patient-controlled epidural analgesia (PCEA) and epidural morphine (EM) for post-cesarean section analgesia in real-world experience from China. METHODS: Parturients receiving one dose of EM (1-2 mg), PCEA, or both EM and PCEA from Peking Union Medical College Hospital were retrospectively recruited. Logistic models were used to identify risk factors. RESULTS: Of 1079 parturients enrolled, 919 (85.2%) parturients received only EM, 105 (9.7%) parturients received PCEA, and 55 (5.1%) parturients received both EM and PCEA. Significantly more parturients from EM group requested supplementary analgesia than those from PCEA and PCEA + EM group (583, 63.4% vs 52, 49.5% vs 25, 45.5%, P = 0.001) with more times of supplementary analgesia (1, IQR: 0-2 vs 0, IQR: 0-1 vs 0, IQR: 0-1 times, P < 0.001) and larger amounts of nonsteroidal anti-inflammatory drugs (NSAIDs) (50, IQR: 0-100 mg vs 0, IQR: 0-50 mg vs 0, IQR: 0-50 mg, P < 0.001). In multivariable Logistic regression for the supplementary analgesia risk, the application of PCEA (OR: 0.557, 95%CI 0.396-0.783, P = 0.001) and the use of NSAIDs intraoperatively (OR: 2.996, 95%CI 1.811-4.957, P < 0.001) were identified as independent predictors. A total of 1040 (96.4%) patients received prophylactic antiemetic therapy during surgery. Only 13 (1.2%) and 7 (0.6%) patients in our cohort requested antiemetic and antipruritic drugs, respectively. CONCLUSION: The use of PCEA was an independent protective factor for supplementary analgesia during the post-cesarean section. Prophylactic antiemetic therapy may reduce the side effects of post-cesarean analgesia.

Assuntos

Analgesia Epidural , Analgesia Controlada pelo Paciente , Analgésicos Opioides , Cesárea , Morfina , Dor Pós-Operatória , Humanos , Feminino , Analgesia Controlada pelo Paciente/métodos , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Cesárea/métodos , Analgesia Epidural/métodos , Morfina/administração & dosagem , Gravidez , Adulto , China , Estudos Retrospectivos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Centros de Atenção Terciária , Analgesia Obstétrica/métodos

RESUMO

PURPOSE OF THE REVIEW: With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens. RECENT FINDINGS: Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.

Assuntos

Cesárea , Dor Pós-Operatória , Humanos , Cesárea/métodos , Feminino , Gravidez , Dor Pós-Operatória/tratamento farmacológico , Manejo da Dor/métodos , Analgesia Obstétrica/métodos , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Analgésicos/uso terapêutico , Bloqueio Nervoso/métodos