scholarly journals Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial

2021 ◽  
Vol 11 (11) ◽  
pp. 1099
Author(s):  
Ying-Hsi Chen ◽  
Wei-Han Chou ◽  
Jr-Chi Yie ◽  
Hsiao-Chun Teng ◽  
Yi-Luen Wu ◽  
...  
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Lower Extremity ◽  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Morphine Group ◽  
First Passage ◽  
Analgesic Effects

Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter–incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p < 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.

scholarly journals Dexamethasone as an Analgesic Adjunct for Postcesarean Delivery Pain: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jennifer E. Mehdiratta ◽  
Jennifer E. Dominguez ◽  
Yi-Ju Li ◽  
Remie Saab ◽  
Ashraf S. Habib ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Intrathecal Morphine ◽  
Controlled Trial ◽  
Skin Incision ◽  
Opioid Consumption ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Cesarean Deliveries ◽  
Analgesic Regimen

Objectives. Dexamethasone has been shown to have analgesic properties in the general surgical population. However, the analgesic effects for women that undergo cesarean deliveries under spinal anesthesia remain unclear and may be related to the timing of dexamethasone administration. We hypothesized that intravenous dexamethasone administered before skin incision would significantly reduce postoperative opioid consumption at 24 h after cesarean delivery under spinal anesthesia with intrathecal morphine. Methods. Women undergoing elective cesarean deliveries under spinal anesthesia were randomly assigned to receive 8 mg of intravenous dexamethasone or placebo prior to skin incision. Both groups received a standardized spinal anesthetic and multimodal postoperative analgesic regime. The primary outcome was cumulative opioid consumption at 24 h. Secondary outcomes included cumulative opioid consumption at 48 h, time to first analgesic request, and pain scores at rest and on movement at 2, 24, and 48 h. Results. 47 patients were analyzed—23 subjects that received dexamethasone and 24 subjects that received placebo. There was no difference in the median (Q1, Q3) cumulative opioid consumption in the first 24 hours following cesarean delivery between the dexamethasone group {15 (7.5, 20.0) mg} and the placebo group {13.75 (2.5, 31.25) mg} ( P = 0.740 ). There were no differences between the groups in cumulative opioid consumption at 48 h, time to first analgesic request, and pain scores. Conclusions. Intravenous dexamethasone 8 mg administered prior to skin incision did not reduce the opioid consumption of women that underwent cesarean deliveries under spinal anesthesia with intrathecal morphine and multimodal postoperative analgesic regimen.

scholarly journals Postoperative Analgesic Effects of Different Doses of Epidural Hydromorphone Coadministered with Ropivacaine after Cesarean Section: A Randomized Controlled Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Meijuan Yang ◽  
Luyang Wang ◽  
Hong Chen ◽  
Yuwen Tang ◽  
Xinzhong Chen
Keyword(s):  
Adverse Effects ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Optimal Dose ◽  
Elective Cesarean Section ◽  
Epidural Administration ◽  
Visual Analogue Pain ◽  
Analgesic Effects ◽  
Elective Cesarean ◽  
Different Doses

Purpose. Single dose of epidural hydromorphone has been introduced to serve as an alternative method for postcesarean section analgesia. However, optimal dose of epidural hydromorphone remains unknown. Hence, we evaluated and compared the analgesic and adverse effects of postoperative different doses of epidural hydromorphone coadministered with ropivacaine after cesarean section. Methods. Eighty term parturients with elective cesarean section under epidural anesthesia were allocated into four groups. Epidural analgesia was administered with an epidural bolus of either 0 mg (group H0), or 0.2 mg (group H1), or 0.4 mg (group H2), or 0.6 mg (group H3) hydromorphone coadministered with ropivacaine. The primary outcome was the visual analogue pain scores (VAPSs) and rescue opioid consumption (PCIA with sulfentanil) in 24 hours. Adverse effects such as respiratory depression, pruritus, nausea, and vomiting were recorded. Results. The VAPSs of group H1 at 2, 4, 6, 12 h and 24 h after surgery was similar to group H0. The VAPSs of group H2 at 4 and 6 h postoperatively were significantly decreased when compared to group H0. But, the VAPSs of group H2 at 2, 12, and 24 h postoperatively were similar to those of group H0. The VAPSs of group H3 at 4, 6, 12 h, and 24 h after surgery were significantly decreased when compared to those of group H0. The total sulfentanil consumption in 24 hours was 90 ± 26 μg in group H0, 75 ± 29 μg in group H1, 54 ± 32 μg in group H2, and 15 ± 16 μg in group H0. Adverse effects were comparable in the four groups. Conclusions. Epidural administration of 0.6 mg hydromorphone coadministered with ropivacaine after cesarean section provided satisfactory pain relief with less sulfentanil consumption. This trial is registered with ChiCTR-IPR-16010026.

scholarly journals Impact of Epidural Analgesia at Different Cervical Dilation on the Rate of Cesarean Delivery

2014 ◽  
Vol 7 (2) ◽  
pp. 153-166
Author(s):  
Xiaofeng Shen
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Labor Pain ◽  
High Rate ◽  
Care Hospital ◽  
Cervical Dilation ◽  
Maternal Characteristics ◽  
Nulliparous Women ◽  
Significant Difference

BACKGROUND: Epidural analgesia is the optimal means in controlling labor pain, whereas the correlation between epidural analgesia at different cervix dilation and corresponding risk of operative delivery remains unclear. OBJECTIVE: The aim of this study was to investigate the association between the epidural analgesia at different cervix and the rate of Cesarean in nulliparous women. METHODS: This is a perspective controlled trial conducted in a University affiliated tertiary women’s health care hospital. After approval by the Institutional Ethical Committee, 780 nulliparous women who underwent spontaneous vaginal delivery at term requesting labor analgesia were screened and 596 of them were assigned into interventions. Subjects were allocated into one of four groups received epidural analgesia initiated at different cervical dilation, i.e. from the onset of painful uterine contraction to the cervix 50.0 mm or greater. The primary outcome was the rate of Cesarean delivery. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery. RESULTS: Five hundred and thirty three subjects completed the study. Significant difference in the rate of Cesarean delivery was observed amongst the four groups (98.9% at cervix <= 10.0mm, 30.2% at cervix 11.0 – 30.0mm, 24.2% at cervix 31.0 – 50.0mm and 18.1% at cervix >= 51.0mm, P < 0.0001). The major reason led to high Cesarean rate at cervix <= 10.0 mm was poor labor progression (75.2%). No significant differences were expressed in variables of non-reassuring fetal status. CONCLUSIONS: Epidural analgesia should be avoided in controlling labor pain at the cervix below 10.0mm due to its influence on the progress of labor resulting in high rate of Cesarean. Maternal characteristics are additional aspects need to be concerned during epidural labor control in nulliparous women. TRIAL REGISTRATION: Epidural Analgesia in Different Cervix Diameter and the Rate of Cesarean Delivery (EACDRCD). ClinicalTrials.gov ID, NCT00677274. http://clinicaltrials.gov/ct2/show/NCT00677274.

scholarly journals Intraoperative Intravenous Methadone and Ketamine Combination versus Intravenous Morphine and Ketamine Combination for Post-Operative Analgesia in Patients Undergoing Lower Extremity Fracture Surgery

2021 ◽  
Vol 3 (4) ◽  
pp. 01-06
Author(s):  
Anupama Wadhwa
Keyword(s):  
Postoperative Pain ◽  
Lower Extremity ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Morphine Group ◽  
Lower Extremity Fracture ◽  
Pain Scores ◽  
Methadone Group ◽  
Extremity Fracture ◽  
Fracture Surgery

Background: Pain management for lower extremity fracture surgeries can be challenging. The purpose of this study is to determine whether the use of ketamine and methadone are more effective than ketamine and morphine to reduce postoperative pain and morphine requirements in patients undergoing lower extremity fracture surgery. Materials and Methods: Seventy-five patients 18-65 years of age, ASA class I-III, were enrolled in this study, which scheduled for elective lower extremity orthopedic surgery involving fracture of femur or tibia were recruited for the study. Thirty-eight randomized to the Methadone group and 37 randomized into the Morphine group. Participants were randomized to either one of the two groups: methadone (2ug/kg fentanyl, 0.2 mg/kg ketamine and 0.2 mg/kg methadone IV) versus control (2 ug/kg fentanyl, 0.2mg/kg ketamine and 0.2 mg/kg morphine IV). The primary outcome was total morphine equivalent (MEQ) during the first 24 and 48 hours after surgery. Secondary outcomes included postoperative pain scores in PACU, at 24 and 48 hours, as well as postoperative nausea and vomiting (PONV). Results: There was no difference in intraoperative consumption of fentanyl between the Methadone group 360mcg and Morphine group 344mcg. In the first 24 hours postoperatively, the Methadone group consumed less MEQ compared with the Morphine group (36.1 mg vs 54.8 mg, p=0.0072), showed lower pain scores than the Morphine group (p=0.0146), and experienced more nausea and vomiting than the Morphine group. There were no differences in sedation in both groups. Conclusion: The intraoperative use of intravenous methadone significantly reduced post-operative opioid requirement in patients undergoing lower extremity fracture surgery. The results also demonstrated the methadone group had a higher rate of PONV.

Efficacy of Epidural Analgesia after Laparotomy in Children

2018 ◽  
Vol 29 (02) ◽  
pp. 209-214 ◽  
Author(s):  
Claudia Keyzer-Dekker ◽  
Monique van Dijk ◽  
Lonneke Staals ◽  
Tom Leeuw ◽  
Rene Wijnen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Epidural Analgesia ◽  
Pain Treatment ◽  
Technical Failure ◽  
Primary Reason ◽  
Successful Group ◽  
Postoperative Pain Treatment

Background Epidural analgesia (EDA) is used as postoperative pain treatment in children, but little is known about its efficacy after laparotomy in children. This retrospective study investigated the efficacy of postoperative EDA after laparotomy in children and the frequencies of adverse effects and complications. Materials and Methods Data of all children aged 0 to 18 years undergoing laparotomy and treated with EDA in our hospital from January 2014 to December 2015 were collected. EDA was classified as successful either if the catheter was removed when there was no further need, and the patient was comfortable with oral/rectal analgesics or when EDA was continued after intervention. Results Ninety children with a median age of 3.7 years were included in the study. In 65% (59/90), EDA was classified as successful. In 34% (20/59) of all successful cases, an additional intervention was needed. In 35% (31/90), the catheter was removed earlier than planned, in half of these cases after an intervention. The primary reason for earlier removal was inadequate analgesia and technical failure. Adverse effects occurred in 18% and complications in 1% of cases. The successful group was significantly younger than the unsuccessful (p = 0.003). Conclusion EDA after laparotomy positively contributed to postoperative pain treatment in two-thirds of children. Numbers of adverse effects and complications were low. It is important to optimize pain management after laparotomy in children; thus, further prospective studies should focus on optimizing EDA and comparing EDA with other techniques of analgesia.

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