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Topic: Epidural analgesia in labour

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Patient controlled analgesia

epidural analgesia

spinal analgesia

Infiltration analgesia

Epidural analgesia in labour

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	HON Mother & Child Glossary, Pain-Relief During Labour & Delivery
		Epidural analgesia may be used for labour and vaginal delivery.
		Epidural, spinal or general anaesthesia may be given safely for cesarean-section deliveries.
		If the mother-to-be already have a labour epidural catheter in place and then need a caesarean delivery, it is usually possible for the anaesthesiologist to inject additional anaesthetic medication through the same catheter to enhance pain relief safely.
	www.hon.ch /Dossier/MotherChild/birth/labour_painrelief.html (769 words)

	Epidural versus non-epidural or no analgesia in labour
		Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour.
		Epidural analgesia appears to be effective in reducing pain during labour.
		Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores.
	www.cochrane.org /reviews/en/ab000331.html (566 words)

	Epidural versus non-epidural analgesia in labour pain
		Epidural analgesia is associated with pain relief during labour, and this is likely to be more effective than alternative treatments.
		Epidural block maintained beyond the end of the first stage is associated with an NNT for assisted vaginal delivery is 9.6 (6.7 to 17) compared with control treatments.
		Painless labour: one of these trials provided dichotomous information suggesting that epidural of bupivacaine preload plus intermittent top up for stage one labour had a NNT of 2.6 (1.8 to 4.7) for painless stage one labour compared with a control of pethidine, nitrous oxide/oxygen inhalation or prudental block given in second stage.
	www.jr2.ox.ac.uk /bandolier/booth/painpag/Acutrev/labour/AP056.html (737 words)

	EPIDURAL ANALGESIA IN DELIVERY INTRODUCED IN THE ROUTINARY ANESTHESIOLOGICAL ACTIVITY: AN OVERVIEW AFTER 5187 ...
		The final result of this approach is that after having withstood the pain and stress of labour, the patient is deprived of the opportunity of seeing her child born, which is the most gratifying part of the entire process.
		Analgesia is achieved in ten minutes and another ten minutes are needed to obtain a stable level of analgesia using the continuous infusion technique.
		Analgesia of the perineum is checked prior to expulsion of the fetus, it should be sufficient if the anesthetic infusion has been ongoing for at least two hours.
	anestit.unipa.it /osting.htm (3191 words)

	How can we use ropivacaine in clinical practice ?
		Nowadays, epidural administration of local anaesthetics is mainly limited to labour analgesia and less commonly to postoperative analgesia.
		Conversely during labour or postoperatively, motor weakness is a drawback of epidural analgesia, impairing the ability to mobilise.
		To conclude, epidural ropivacaine in concentrations less than 0.2% is appropriate for labour or postoperative analgesia, as long as it is combined with an opiate to strengthen the quality of analgesia.
	www.euroanesthesia.org /education/rc_vienna/08rc2.HTM (1979 words)

	Patient controlled epidural analgesia for labour
		Patient controlled epidural analgesia were less likely to need unscheduled anaesthetic interventions, receive a slightly lower dose of local anaesthetic, and have less motor block than those who have continuous epidural infusion.
		The relative risk was 1.7 (1.4 to 2.0) and the number of women needed to be treated with patient controlled epidural analgesia rather than continuous epidural infusion to prevent one needing an unscheduled top up was 3.6 (2.8 to 5.2).
		On the face of it, patient controlled epidural analgesia has benefits, though much more time would need to be given to patient education.
	www.jr2.ox.ac.uk /bandolier/booth/painpag/Acutrev/labour/PCEA.html (307 words)

	International Breastfeeding Journal \| Full text \| Intrapartum epidural analgesia and breastfeeding: a prospective ...
		Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI 1.53, 2.67).
		Similarly, a study undertaken in Lapland of 64 primiparous women with spontaneous vaginal births found women who had epidural analgesia were more likely to be either partially breastfeeding or formula feeding at 12 weeks postpartum than women who had not had epidural analgesia (relative risk 2.27, 95% CI 1.27, 4.04) [6].
		In this study, women who had epidural analgesia, a general anaesthetic and/or a caesarean section for the birth of their baby were more likely to be partially breastfeeding their baby in the first week postpartum.
	www.internationalbreastfeedingjournal.com /content/1/1/24 (3559 words)

	Epidurals Can Cause Fever - FROM RONNIE Falcão's MIDWIFE ARCHIVES
		Epidurals are already known to increase maternal core temperature but the physiologic pathways is not certain.
		In cases of prolonged labor (as is found in epidural labors), cesarean section and induction newborn sepsis/infection is often suspected when there is a rise in the newborn's temperature.
		Epidural Analgesia in Labor and Fetal Hyperthermia, Obstetrics and Gynecology, Vol.
	www.gentlebirth.org /archives/epdrlfvr.html (643 words)

	Pain Relief in Labour - Patient UK
		Women taught self-hypnosis had decreased requirements for pharmacological analgesia including epidural analgesia and were more satisfied with their pain management in labour compared with controls.
		Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain.
		Staying mobile in the first stage of labour for women with epidural analgesia has not been shown to produce any benefit to delivery outcomes or satisfaction with analgesia, but there are no obvious harms either.
	www.patient.co.uk /showdoc/40000218 (1416 words)

	Research Publications (Site not responding. Last check: 2007-10-29)
		The provincial epidural analgesia rate was 27.5 (per 100 hospital deliveries) in 1998, compared with 14.0 in 1994.Table A50 and Figure 23 show the 1994 rates for regional health authorities, compared to those of 1998.
		The highest epidural rate amongst urban hospitals was 53.0% at the Foothills Hospital in Calgary; the rate for this hospital was the same in 1994.
		The availability of epidural analgesia was not totally dependent on hospital size; some hospitals with epidural service for anesthesia did not provide epidural analgesia service.
	www.asac.ab.ca /Pubs/AlbertaReproductiveHealth2001/epiduralAnalgesia.html (353 words)

	Educational Synopses in Anesthesiology and Critical Care Medicine Vol 5 No 4 (Site not responding. Last check: 2007-10-29)
		Disadvantages of conventional epidural analgesia for the anesthetist are a need for an anesthetist to be "physically present" or "immediately available to intervene appropriately." (CAS guidelines for a bolus injection of local anesthetic) In addition, conventional epidural analgesia is associated with sympathetic blockade and hypotension.
		Pain from the 1st stage of labour, which arises from dilatation of the cervix and distention of the lower uterine segment, is transmitted along A-delta and C fibers.
		The epidural dose may include 25 to 75 ug k of fentanyl with bupivacaine 0.01 - 0.125 % or sufentanil 10 ug in 10 ml of bupivacaine 0.125 to 0.25 % Sufentanil is the narcotic of choice for both intrathecal and epidural analgesia of labour.
	www.gasnet.org /esia/1998/april (2738 words)

	Update in Anaesthesia Issue 18
		Pain during the first stage of labour is due to distention of the lower uterine segment, mechanical dilatation of the cervix and lastly due to stretching of excitatory nociceptive afferents resulting from the contraction of the uterine muscles
		Analgesia during labour can be provided by the inhalational anaesthetic agents in subanaesthetic concentrations thus relieving pain whilst maintaining maternal consciousness and avoiding regurgitation or aspiration of stomach contents.
		For analgesia in labour it is given in doses of 10-20mg intramuscularly.
	www.nda.ox.ac.uk /wfsa/html/u18/u1803_01.htm (2285 words)

	NGC - NGC Summary
		Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin?.
		The effect of intrathecal and epidural narcotic analgesia on the length of labor.
		Prophylactic intravenous preloading for regional analgesia in labour.
	www.guideline.gov /summary/select_ref.aspx?doc_id=2928 (1004 words)

	All About Epidurals: Articles about Breastfeeding, childbirth, and pregnancy online magazine: The Compleat Mother
		These forms of "walking epidural" may seem advantageous, but being attached to a CTG machine to monitor the baby, and hooked up to a drip which is also a requirement when an epidural is in place, can make walking impossible.
		An epidural will often slow a woman's labour, and she is three times more likely to be given an oxytocin drip to speed things up(6, 7).
		While an epidural is certainly the most effective form of pain relief available, it is worth considering that ultimate satisfaction with the experience of giving birth may not be related to lack of pain.
	www.compleatmother.com /epidural.htm (2079 words)

	Epidural And Progression Of Labour Content, Information And Facts (Site not responding. Last check: 2007-10-29)
		Jan 23, 2003 although epidural analgesia during labor may be linked measures are effect on progression of labour pain relief a newborn's first day of life breastfeeding.
		Nulliparous women in spontaneous labor who were requesting analgesia were randomized to receive either epidural analgesia 97 patients, consisting of 0.08 bupivacaine and 1.67 micro g mL fentanyl, or intravenous analgesia 88 patients, consisting of fentanyl.
		The 226 mothers assigned to epidural analgesia were not significantly different from the 233 mothers assigned to intravenous meperidine.
	www.epiduralresearch.info /epidural-and-progression-of-labour.html (1376 words)

	Prophylactic intravenous preloading for regional analgesia in labour
		Regional (epidural, spinal or combined spinal-epidural) analgesia is a common form of pain relief used during labour.
		In one epidural trial using high-dose local anaesthetic, preloading with intravenous fluids was shown to counteract the hypotension which frequently follows traditional epidural analgesia (relative risk (RR) 0.07, 95% confidence interval (CI) 0.01 to 0.53; 102 women).
		In the two epidural low-dose anaesthetic trials, no significant difference in maternal hypotension was found (RR 0.73, 95% CI 0.36 to 1.48; 260 women), although they were underpowered to detect less than a very large effect.
	www.cochrane.org /reviews/en/ab000175.html (618 words)

	JPMA ::: (Site not responding. Last check: 2007-10-29)
		Epidural analgesia (EA) is widely used as an effective method of relieving labor pain.
		This study reveals the fears and misconceptions of our women with regard to labour analgesia and provides information on areas where interventions can be done to increase the epidural acceptance rate.
		However, the results of our study cannot be generalized as it was conducted in only one centre providing epidural analgesia for labor and most of the study participants were educated and working females.
	jpma.org.pk /JPMA/02feb05/fulltext5.htm (1059 words)

	Epidural During Labour Does Not Increase Cesarean Delivery Rates
		CHICAGO, IL -- Dec. 22, 1998 -- The use of epidural analgesia (continuous infusion of medication into the spinal canal) for pain relief during labour does not significantly increase the rate of cesarean delivery as previously believed.
		The first and second stages of labour were longer in patients who received epidural pain relief compared to those who received narcotic injections.
		"The neonates [newborns] of mothers receiving epidural analgesia were more alert, had a lower incidence of mild acidosis [an accumulation of acid in the blood] and required naloxone [a drug that reverses the effects of narcotics] less frequently than the neonates of mothers receiving parenteral opioids.
	www.docguide.com /dg.nsf/PrintPrint/3C194C00DEB495FD852566E2007144B2 (696 words)

	Epidural linked to abnormal head position \| DoctorNDTV: Health news on Epidural linked to abnormal head position
		Receiving epidural analgesia during labour seems to increase the risk that the baby will be delivered face up instead of the normal face-down position.
		Ultrasound examinations were performed when women were first admitted to the labour and delivery unit, at the time of epidural administration or 4 hours after the initial examination, and when they were close to full dilatation.
		Epidural analgesia was not associated with the sideways-facing position.
	www.doctorndtv.com /news/detailnews.asp?id=1430 (315 words)

	Clinical Trial: Comparing Skin Disinfectants Before Labour Epidural Analgesia
		Epidural catheters are usually colonized by the flora present at the skin insertion site and the rate of colonization varies from 5 to 30%.
		Epidurals will be placed between the L3 and L5 interspaces using a 17 gauge Tuohy needle, by loss of resistance to air or saline depending on operator choice.
		Ten seconds later, the epidural catheter is removed by a researcher wearing a mask and sterile gloves, using sterile forceps, and the distal 3-4 cm is transacted with a sterile scissors.
	www.clinicaltrials.gov /ct/show/NCT00247897 (1446 words)

	Combined spinal-epidural versus epidural analgesia in labour
		Epidural, is when the anaesthetic drugs are given through a very fine tube into the space around the spinal column (epidural space).
		CSE is believed to improve maternal mobility during labour and provide more rapid onset of analgesia than epidural analgesia, which could contribute to increased maternal satisfaction.
		No differences between CSE and epidural were seen for maternal satisfaction, mobilisation in labour, modes of birth, incidence of post dural puncture headache or blood patch and maternal hypotension.
	www.cochrane.org /reviews/en/ab003401.html (795 words)

	New study shows epidural during birth may negatively affect breastfeeding
		Epidurals given during labour and birth are associated with decreased rates of breastfeeding, both in the short and long term.
		Torvaldsen et al.’s results show that although most (93%) women breastfed their baby in the first week, epidural anesthesia was significantly associated with difficulty breastfeeding in the few days after birth and with partial breastfeeding in the first week after delivery.
		In addition, the 416 women who had epidurals were twice as likely to completely stop breastfeeding before six months compared with women who used no analgesia, after controlling for maternal age and education.
	www.eurekalert.org /pub_releases/2006-12/bc-nss120606.php (366 words)

	Epidural versus non-epidural or no analgesia in labour (Site not responding. Last check: 2007-10-29)
		Women who receive epidurals during labor report less pain than those who choose opiates or natural childbirth, according to a systematic review of evidence.
		Epidural analgesia involves injecting a local anesthetic into the lower back to block pain impulses from the uterus and birth canal.
		The precise timing of the epidural injection may be an important factor, says Todd Liu, M.D., a fellow of the American College of Obstetricians and Gynecologists who practices in New Jersey.
	www.news-medical.net /?id=14679 (628 words)

	ASA November 2001 Newsletter
		Robert D’Angelo, M.D. The use of epidural patient-controlled analgesia, more commonly referred to as patient-controlled epidural analgesia (PCEA), is becoming increasingly popular in treating labor pain because the technique offers theoretical advantages over intermittent bolus and continuous infusion techniques.
		With projections indicating that the number of deliveries and utilization of epidural analgesia will increase in the future while the number of anesthesia care providers will decrease, it is easy to see why the PCEA technique is so appealing.
		Epidural PCA with bupivacaine 0.125 percent, sufentanil 0.75 microgram and epinephrine 1/800.000 for labor analgesia: Is a background infusion beneficial?
	www.asahq.org /Newsletters/2001/11_01/dangelo.htm (1330 words)

	Epidural Anesthesia - Obstetric Myths VS Realities
		Women who had epidurals made up half the group (7 of 14) that had to be excluded from the spontaneous arm because they required forceps.
		No woman who had an epidural was in the group (none of 13) that was excluded from the forceps arm because spontaneous birth was imminent.
		Epidural mothers were more likely to have malpositions (0 unmedicated, 25% epidural, 40% oxytocin and epidural, p <0.02) and forceps deliveries (0 unmedicated, 60% epidural, 80% oxytocin and epidural, p < 0.01).
	www.moondragon.org /obgyn/pregnancy/epiduralobmyth3.html (2402 words)

	Research Publications (Site not responding. Last check: 2007-10-29)
		The provincial epidural analgesia rate was 27.5 (per 100 hospital deliveries) in 1998, compared with 14.0 in 1994.Table A50 and Figure 23 show the 1994 rates for regional health authorities, compared to those of 1998.
		The highest epidural rate amongst urban hospitals was 53.0% at the Foothills Hospital in Calgary; the rate for this hospital was the same in 1994.
		The availability of epidural analgesia was not totally dependent on hospital size; some hospitals with epidural service for anesthesia did not provide epidural analgesia service.
	asac.ab.ca /Pubs/AlbertaReproductiveHealth2001/epiduralAnalgesia.html (353 words)

	IngentaConnect Intrathecal sufentanil compared with epidural bupivacaine analges... (Site not responding. Last check: 2007-10-29)
		Epidural analgesia for pain relief during labour has certain disadvantages including slow onset.
		The aim of this study was to compare the analgesia and the side effects of intrathecal sufentanil with epidural bupivacaine during labour.
		The rapid onset and effective analgesia of intrathecal sufentanil may in certain situations be advantageous.
	www.ingentaconnect.com /content/gmed/eja/1997/00000014/00000006/art00014 (251 words)

	Does epidural analgesia increase rate of cesarean section?
		Epidural analgesia (EA) is clearly the most effective form of pain relief during labour.
		Oxytocin augmentation of labour was found in 52% of women who received EA and in 7% of women who received narcotics.
		Epidural analgesia use as a marker for physician approach to birth: implications for maternal and newborn outcomes.
	www.cfpc.ca /cfp/2006/Apr/vol52-apr-editorials-2.asp (2233 words)

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