835 results on '"Combined spinal epidural"'
Search Results
2. Comparison of epidural, combined spinal epidural, and dural puncture epidural techniques for labor analgesia
- Author
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Ranjana Khetarpal, Veena Chatrath, Suparna Grover, Puneetpal Kaur, Ankita Taneja, and Aishwarya Madaan
- Subjects
combined spinal epidural ,dural puncture epidural ,labor analgesia ,Anesthesiology ,RD78.3-87.3 ,Gynecology and obstetrics ,RG1-991 - Abstract
Background: Lumbar epidural analgesia is a safe, effective, and beneficial technique for both the parturient and the fetus. Dural puncture epidural has been claimed to be better than combined spinal epidural and epidural techniques by many. We undertook this study to compare the three techniques regarding duration, quality of analgesia, and side effects. Debate regarding the best neuraxial technique for labor analgesia continues. Materials and Methods: The parturients of ASA grade I and II of age group 20–35 years were randomly divided into three groups of 20 each. Group E (epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 μg fentanyl in the epidural space. Group CSE (combined spinal epidural group) received 2.5 mg of intrathecal isobaric levobupivacaine with 25 μg fentanyl and epidural top up of 15 ml of 0.125% levobupivacaine with 30 μg fentanyl. Group DPE (dural puncture epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 μg fentanyl in epidural space; intrathecal medication was withheld. Epidural top-up doses were given as per Visual Analog Scale (VAS). Analgesic efficacy, extent of sensory and motor block, maternal and fetal outcome, duration of analgesia, and maternal satisfaction score were compared among three groups and analyzed statistically. Results: The onset and symmetry of sensory blockade and VAS score were better in CSE group. DPE group had better sacral coverage and less asymmetric blockade. Groups CSE and DPE had superior maternal and surgeon satisfaction scores in comparison to group E. Both groups E and DPE provided analgesia with minimal motor blockade and ambulation.
- Published
- 2024
- Full Text
- View/download PDF
3. The clinical effects of combined spinal epidural anaesthesia versus spinal anaesthesia in major surgeries.
- Author
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P. S., Kalesh, B., Geethashree, U. L., Sagarika, and R., Thanuja
- Subjects
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EPIDURAL anesthesia , *EPIDURAL catheters , *ANESTHESIA , *BUPIVACAINE , *ABDOMINAL surgery , *SPINAL infusions - Abstract
Combined Spinal Epidural Anaesthesia (CSEA) combines advantages of both component techniques while precluding their known disadvantages. Further, a low dose intrathecal Bupivacaine followed by sequential epidural doses calculated as per the unblocked number of segments may provide sufficient volume extension to precisely and adequately target the required surgical field. 66 patients scheduled for major surgeries under neuraxial anaesthesia were randomized into two groups. GROUP A (n=33) received CSEA with 1.5 ml 0.5% Hyperbaric Bupivacaine (7.5 mg) intrathecally at L3-L4 site followed by 0.75 ml (16 patients) to 1.5 ml (17 patients) 0.5% plain Bupivacaine per unblocked segments through epidural catheter. GROUP B (n=33) received only 2.5 ml 0.5% Hyperbaric Bupivacaine (12.5 mg) intrathecally at L3-L4 site. The maximun level of sensory block was T11 after spinal component of CSEA in group A and T6 in group B. In group a, subsequent epidural dosing of 0.5% Bupivacaine with 1.5 ml per unblocked segments (stat/increment) in 17 patients raised the level by 6-segments. In the other subgroup of 16 patients who received 0.75 ml per segment epidural dose, there was 4-segment raise in block level. Time for 2-segment regression was 0.6±0.2 hours (Group A) compared to 2.4±0.5 hours (Group B) with p<0.001. The total duration of sensory block was 1.9±0.4 hours (Group A) and 4.8 ± 1 hours (Group B) with p< 0.001. For CSEA in major abdominal surgeries, an intrathecal dose of 1.5 ml 0.5% Hyperbaric Bupivacaine (7.5 mg) is sufficient as initialising dose. The surgical need of analgesia for uncovered segments can be provided predictably with epidural 0.5% plain Bupivacaine as increments of 0.75 ml per required segment. [ABSTRACT FROM AUTHOR]
- Published
- 2024
4. Comparison of epidural, combined spinal epidural, and dural puncture epidural techniques for labor analgesia.
- Author
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Khetarpal, Ranjana, Chatrath, Veena, Grover, Suparna, Kaur, Puneetpal, Taneja, Ankita, and Madaan, Aishwarya
- Subjects
- *
EPIDURAL space , *EPIDURAL analgesia , *ANALGESIA , *VISUAL analog scale - Abstract
Background: Lumbar epidural analgesia is a safe, effective, and beneficial technique for both the parturient and the fetus. Dural puncture epidural has been claimed to be better than combined spinal epidural and epidural techniques by many. We undertook this study to compare the three techniques regarding duration, quality of analgesia, and side effects. Debate regarding the best neuraxial technique for labor analgesia continues. Materials and Methods: The parturients of ASA grade I and II of age group 20–35 years were randomly divided into three groups of 20 each. Group E (epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 μg fentanyl in the epidural space. Group CSE (combined spinal epidural group) received 2.5 mg of intrathecal isobaric levobupivacaine with 25 μg fentanyl and epidural top up of 15 ml of 0.125% levobupivacaine with 30 μg fentanyl. Group DPE (dural puncture epidural group) received 15 ml of 0.125% isobaric levobupivacaine with 30 μg fentanyl in epidural space; intrathecal medication was withheld. Epidural top-up doses were given as per Visual Analog Scale (VAS). Analgesic efficacy, extent of sensory and motor block, maternal and fetal outcome, duration of analgesia, and maternal satisfaction score were compared among three groups and analyzed statistically. Results: The onset and symmetry of sensory blockade and VAS score were better in CSE group. DPE group had better sacral coverage and less asymmetric blockade. Groups CSE and DPE had superior maternal and surgeon satisfaction scores in comparison to group E. Both groups E and DPE provided analgesia with minimal motor blockade and ambulation. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
5. Sonographic Locating of the Lumbar Space in the Difficult Spine and Obese Parturient: Simulation and Skills
- Author
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Atasever, Ayse Gulsah, Van De Velde, Marc, Cinnella, Gilda, editor, Beck, Renata, editor, and Malvasi, Antonio, editor
- Published
- 2023
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6. Neuraxial analgesia in labour and the foetus.
- Author
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Kearns, R.J. and Lucas, D.N.
- Abstract
Providing pain relief during labour is a fundamental human right and can benefit both mother and foetus. Epidural analgesia remains the 'gold standard', providing excellent pain relief, as well as the facility to convert to anaesthesia should operative intervention be required. While maternal well-being remains the primary focus, epidural analgesia may also have implications for the foetus. Data from meta-analyses finds that epidural compared with systemic opioids in labour is associated with reduced neonatal respiratory depression. Clinically relevant neonatal outcomes such as Apgar score <7 at 5 min, neonatal resuscitation and need for admission to a neonatal unit are reassuring, with the benefits of epidural analgesia for both mother and neonate outweighing any potential risks. Recent concerns regarding an association of epidural with the development of autism spectrum disorder in childhood appear to be unfounded, with several large observational studies refuting this association. This review discusses the evidence relating to maternal neuraxial analgesia in labour, implications for the foetus in utero , and childhood outcomes both in the immediate peripartum period and longer term. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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7. Comparison between intermittent epidural bolus of levobupivacaine 0.125% and ropivacaine 0.2% with fentanyl as adjuvant for combined spinal epidural technique in labor analgesia: A double blinded prospective study.
- Author
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Thammaiah, Srinivas, Sreenath, Rashmi, Swamy, Akshay, Kumararadhya, Girish, and Priya, Sushant
- Subjects
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DELIVERY (Obstetrics) , *ROPIVACAINE , *FENTANYL , *ANALGESIA , *LABOR (Obstetrics) - Abstract
Objective: This study aims to compare levobupivacaine 0.125% and ropivacaine 0.2% with fentanyl as epidural drugs for labor analgesia using combined spinal epidural (CSE) technique regarding time for onset, duration of analgesia achieved by first epidural bolus dose and to compare the quality of labor analgesia. In addition, the study is also designed to assess the maternal and fetal outcome, incidence of instrumental delivery, degree of motor blockade, and maternal satisfaction. Materials and Methods: Following approval from Institutional Ethical Committee, 50 American Society of Anesthesiologists Physical Status II pregnant women requesting labor analgesia, satisfying the inclusion criteria were randomly divided equally into Groups L and R. CSE performed, 0.5 ml hyperbaric bupivacaine 0.5% with fentanyl 25 mcg administered intrathecally. IEBs 10 ml of study drugs given through epidural catheter as demand dose. Results: The mean onset of analgesia with Group R and group L were 16.280 ± 1.59 min and 21.480 ± 1.32 min(P = 0.000) respectively. The total duration of analgesia in Group R = 72.08 ± 1.97 min, whereas Group L = 82.160 ± 2.07 min (P = 0.000). There was no difference between the groups in terms of maternal demographic traits, mode of delivery, maternal and fetal outcome, and maternal satisfaction. Both 0.125% levobupivacaine and 0.2% ropivacaine produce excellent-quality of analgesia. Conclusion: Ropivacaine produces an early onset of analgesia than levobupivacaine but levobupivacaine had significantly prolonged analgesia compared to ropivacaine. Both drugs were found to be safe for labor analgesia. Maternal satisfaction and fetal outcome were similar with both the drugs. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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8. Neuraxial analgesia in labour – induction and maintenance.
- Author
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Markey, Thomas and Zacharzewski, Amanda
- Abstract
Epidurals were introduced for labour analgesia in the 1940s, and since then they have become the gold standard for analgesia in delivery units globally. Although some controversy remains with regards to the effect of neuraxial blockade on the fetus, it is now established that the benefits are significant. As a result of the introduction of low-dose concentration local anaesthetic mixtures, issues surrounding cardiovascular effects and toxicity have become much less of a concern. The profound motor block found with traditional regimens is much less of a problem resulting in improved maternal satisfaction, although the advent of mobile epidurals has not yet been fully established. Research continues to develop new technologies to provide safer and more individualized neuraxial analgesia tailored to the labouring parturient that seek more control and autonomy over their delivery. No modern technique can emulate the theoretical ideal; however, women can experience safe and effective analgesia with minimal risk to both themselves and their babies. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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9. The effect of combined spinal epidural versus epidural analgesia on fetal heart rate in laboring patients at risk for uteroplacental insufficiency.
- Author
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Maetzold, Erin, Lambers, Donna S., Devaiah, C. Ganga, and Habli, Mounira
- Subjects
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FETAL heart rate , *EPIDURAL analgesia , *FETAL growth retardation , *FETAL heart , *BLOOD pressure - Abstract
Background: The effects of neuraxial analgesia on fetal heart tracings have been studied in "healthy" pregnancies. Our objective was to compare the impact of intrapartum epidural analgesia (EA) versus combined spinal epidural analgesia (CSE) on fetal heart rate changes in pregnancies at risk for uteroplacental insufficiency (UPI).Methods: Singleton pregnancies diagnosed with chronic hypertension, gestational hypertension and/or preeclampsia, and/or fetal growth restriction (FGR) and receiving neuraxial analgesia intrapartum from 2012 to 2015 were studied retrospectively. The primary outcome was change in fetal heart rate (FHR) category following neuraxial analgesia. Manual review of all FHR tracings was performed and classified by the National Institute of Child Health and Human Development (NICHD) categories. Data collection included maternal demographics, blood pressure, uterine tachysystole, uterine hypertonus, mode of delivery, interventions for FHR abnormalities and neonatal outcomes.Results: Of laboring patients at risk for UPI, 110 patients received EA and 127 patients received CSE. The rate and change in FHR categories and abnormalities following neuraxial analgesia were the same in both groups. Both EA and CSE resulted in a significant increase in NICHD FHR category II, from 27.3 to 65.5% for EA and 20.9 to 64.3% for CSE. The occurrence of maternal hypotension, uterine tachysystole, interventions for FHR abnormalities, and uterine hypertonus following neuraxial analgesia was not found to be significantly different between the two groups. When compared to the EA group, CSE had a higher rate of NICU admission (29.5 versus 16.4%, p = .021).Conclusions: FHR category increased following both CSE and EA. The side effects of maternal hypotension and need for fetal interventions was not different between CSE and EA. [ABSTRACT FROM AUTHOR]- Published
- 2022
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10. Central Neuraxial Anatomy and Anesthetic Application (Central Neuraxial Blockade)
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Harrison, Nathan J., Daste, Laurie S., McDaniel, Gary S., Jr, Patterson, Matthew E., Guirguis, Maged, Farag, Ehab, editor, Argalious, Maged, editor, Tetzlaff, John E., editor, and Sharma, Deepak, editor
- Published
- 2018
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11. Don’t stress: a case report of regional anesthesia as the primary anesthetic for gynecologic surgery in a patient with mitochondrial myopathy and possible malignant hyperthermia susceptibility
- Author
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Marci B. Pepper, Catherine Njathi-Ori, and Michelle Ochs Kinney
- Subjects
Regional anesthesia ,Combined spinal epidural ,Mitochondrial myopathy ,Malignant hyperthermia ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background We aim to describe the evaluation and management of a patient with the uncommon combination of both mitochondrial myopathy and possible malignant hyperthermia susceptibility as an important source of information and as a valuable example of the role of regional anesthesia for patients with these diagnoses. Case presentation A 24 year old woman with a history of possible mitochondrial myopathy and possible malignant hyperthermia susceptibility presented for gynecologic surgery. Surgery was well tolerated with combined spinal epidural anesthesia as well as sedation with midazolam, ketamine, and fentanyl. Conclusions Anesthetic management of patients with mitochondrial myopathy is challenging, made even more so with concurrent malignant hyperthermia susceptibility. This case adds an example to the literature of employing regional anesthesia as a safe approach to this complex care.
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- 2019
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12. Is combined spinal-epidural more effective compared to epidural for labor analgesia?
- Author
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Jerry Joseph Joel, Narjeet K Osahan, Ekta Rai, Priyanka Daniel, and Sunimal Bhaggien
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Combined spinal epidural ,epidural ,labor analgesia ,Medicine ,Nursing ,RT1-120 - Abstract
Aims and Objectives: This study aims to compare the effectiveness of combined spinal-epidural (CSE) analgesia and low-dose epidural analgesia in labor and study their effects on maternal and fetal well-being. Material and Methods: Sixty parturients classified as the American Society of Anesthesiologists I, in established labor and requesting epidural, were alternately divided into two groups (30 each). Group I received 0.125% bupivacaine with fentanyl 2 ug/ml epidural analgesia. Group II received CSE analgesia comprising of 25 μg fentanyl in the intrathecal space and 0.125% bupivacaine with fentanyl 2 ug/ml for epidural analgesia. Onset of analgesia, maternal hemodynamics, fetal heart rate, duration of labor, ambulation, incidence of cesarean section, instrumental delivery, side effects, and total dose of bupivacaine and fentanyl used were recorded. Results: Onset of analgesia in CSE group (1.48 ± 0.46 min) was significantly faster compared to the epidural group (3.87 ± 0.83 min). Duration of the first stage of labor was shorter in the CSE group (218.93 ± 78.15 min) compared to epidural group (308.03 ± 147). No significant difference between the groups was found in hemodynamic effects, duration of the second stage of labor, or in maternal and neonatal outcomes. Pruritus was seen in 50% of CSE patients. Mean total bupivacaine used in CSE group was significantly lesser than that used in Group I (56.750 ± 22.33 mg vs. 79.325 ± 28.81 mg). Conclusion: Both CSE and epidural analgesia provide comparable pain relief and maternal and fetal outcomes. CSE can be beneficial for parturients coming in advanced labor as its onset of action is faster.
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- 2019
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13. Labor and Delivery
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Kovacheva, Vesela, Aglio, Linda S., editor, and Urman, Richard D., editor
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- 2017
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14. Epidural Blockade: Safe Practice and Management of Adverse Events
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Gaff, Steven J., Finucane, Brendan T., editor, and Tsui, Ban C.H., editor
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- 2017
- Full Text
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15. The 90% effective dose of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia in parturients with super obesity: an up-down sequential allocation study.
- Author
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Tan HS, Fuller ME, Barney EZ, Diomede OI, Landreth RA, Pham T, Rubright SM, Ernst L, and Habib AS
- Subjects
- Female, Humans, Pregnancy, Anesthetics, Local, Bupivacaine, Double-Blind Method, Fentanyl, Morphine, Obesity, Anesthesia, Epidural, Anesthesia, Obstetrical methods, Anesthesia, Spinal
- Abstract
Purpose: To determine the 90% effective dose (ED
90 ) of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia (CSE) in parturients with super obesity (body mass index [BMI] ≥ 50 kg·m-2 )., Methods: We enrolled parturients with BMI ≥ 50 kg·m-2 with term, singleton vertex pregnancies undergoing elective Cesarean delivery under CSE. An independent statistician generated the 0.75% hyperbaric bupivacaine dosing regimen in increments of 0.75 mg using a biased-coin up-down sequential allocation technique. This was combined with 15 μg fentanyl, 150 μg morphine, and normal saline to a volume of 2.05 mL. The initial and maximum doses were 9.75 mg and 12 mg, respectively. Participants, clinical team, and outcome assessors were blinded to the dose. The primary outcome was block success, defined as T6 block to pinprick within ten minutes and no intraoperative analgesic supplementation within 90 min of spinal injection. We determined the ED90 using logistic regression., Results: We enrolled 45 parturients and included 42 in the analysis. All doses achieved a T6 level within ten minutes, and the primary outcome occurred in 0/1 (0%) of the 9.75-mg doses, 2/3 (67%) of the 10.5-mg doses, 21/27 (78%) of the 11.25-mg doses, and 11/11 (100%) of the 12-mg doses. The ED90 of hyperbaric bupivacaine was 11.56 mg (95% confidence interval, 11.16 to 11.99). Four parturients (9.5%) had sensory level higher than T2, but none was symptomatic or required general anesthesia., Conclusion: The estimated ED90 of hyperbaric bupivacaine with fentanyl and morphine in parturients with super obesity undergoing Cesarean delivery under CSE was approximately 11.5 mg., Study Registration: ClinicalTrials.gov (NCT03781388); first submitted 18 December 2018., (© 2024. Canadian Anesthesiologists' Society.)- Published
- 2024
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16. Comparison of epidural technique with combined spinal epidural technique for labor analgesia
- Author
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Patel, Dhaval Kumar C. and Kavishvar, Neeta Abhay
- Published
- 2018
- Full Text
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17. Continuous psoas sciatic blockade for total knee arthroplasty
- Author
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Wesameldin A Sultan, Ezzeldin S Ibrahim, and Mohamed S El-Tahawy
- Subjects
Combined spinal epidural ,knee arthroplasty ,psoas sciatic blockade ,Anesthesiology ,RD78.3-87.3 - Abstract
Background: Psoas sciatic block (Pso/Sci) is a modern anesthetic technique for lower extremities surgery. The use of this technique can avoid the adverse effects of the general anesthesia or the central neuroaxial blockade, especially in patients with multiple comorbidities. Purpose: The purpose of this study is to compare the efficacy of combined Pso/sci as a sole anesthetic technique with conventional combined spinal epidural (CSE) anesthesia for patients undergoing total knee arthroplasty. Methods: Eighty patients scheduled for total knee replacement were included in the study. Patients were divided into two equal groups: Pso/sci group received ultrasound guided with the use of nerve locator continuous Pso/sci and the second group (CSE) received CSE anesthesia. Onset of sensory and motor block time, hemodynamic changes, contralateral spread, first-time need for analgesia, incidence of complications, and patient and surgeon satisfactions were recorded. Results: The block time was significantly higher in the (Pso/Sci) group. Two patients in (Pso/Sci) had contralateral spread. Sensory and motor block onsets were delayed significantly in (Pso/Sci). Hemodynamic changes occurred in the CSE; however, it was insignificant compared to Pso/sci group. The first analgesic request was significantly later in (Pso/Sci) compared to the CSE group. There were no differences found in both groups as regard complications, early mobilization, and patients and surgeons satisfaction. Conclusions: Psoas sciatic block is an alternative safe and successful anesthetic technique, which can provide an adequate anesthesia for total knee surgery with less hemodynamic changes.
- Published
- 2018
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18. An observational study to evaluate the effect of different epidural analgesia regimens on dynamic pain scores in patients receiving epidural analgesia for postoperative pain relief after elective gynecological surgery
- Author
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Manpreet Singh, Ranju Singh, and Aruna Jain
- Subjects
Bupivacaine ,clonidine ,combined spinal epidural ,fentanyl ,gynecological surgery ,morphine ,postoperative pain ,Anesthesiology ,RD78.3-87.3 ,Pharmacy and materia medica ,RS1-441 - Abstract
Background and Aims: The primary measure of efficacy of any analgesic regimen is pain relief, but it is important to measure dynamic pain relief rather than pain relief at rest. Epidural analgesia is an effective technique for postoperative analgesia. The drug combinations given therein (local anesthetics with adjuvants such as opioids/alpha-2 agonists), however, remain a personal choice. The aim of this study was to evaluate dynamic pain scores in patients receiving different epidural analgesia regimens for postoperative pain relief after elective gynecological surgery used in our institution. Material and Methods: One hundred eighty-seven patients enrolled in this study received postoperatively either bupivacaine 0.125% + morphine 0.1 mg/mL (group BM) or bupivacaine 0.125% + fentanyl 2 μg/mL (group BF) or bupivacaine 0.125% + clonidine 1 μg/mL (group C1) or bupivacaine 0.125% + clonidine 2 μg/mL (group C2) by continuous epidural infusion @ 5 mL/h. Differences in dynamic pain scores (on coughing and mobilization), pain scores at rest, sensory and motor blockade, sedation scores, dry mouth, pruritus, nausea, and vomiting were recorded. Also duration of postoperative analgesia, epidural top-ups, requirement of rescue analgesic, and patient satisfaction were determined. All observations were carried out at 1, 2, 4, 8, and 12 h after surgery and then at 8 am, 12 noon, 4 pm, 8 pm on subsequent postoperative day till removal of epidural catheter (after 96 h). Results: There was no difference in demographic or hemodynamic profile among the four groups (P > 0.05). There was no statistically significant difference in pain scores at rest among the four groups but dynamic pain scores were found to be better in group C2 as compared to group BM, BF, and C1 at most of the time intervals although not statistically significant (P > 0.05). Requirement of rescue analgesics was lower in group BM and group C2 as compared to group BF and C1 (P < 0.01). Incidence of pruritus was 43.5% in group BM and 19% in group BF, while no patients in group C1 or C2 had pruritus. Mean postoperative nausea and vomiting (PONV) scores were higher in group BM and group BF as compared to group C1 and C2 (P < 0.001). Mean sedation scores were comparable in all four groups. Incidence of dry mouth was 22% in group C2 as compared to 11% in group C1, while no patients in group BM or BF had dry mouth. Patients in group C2 were more satisfied as compared to other three groups. Conclusions: Combination of clonidine 2 μg/mL to 0.125% bupivacaine @ 5 mL/h in combined spinal epidural provides better postoperative analgesia as compared to combination of bupivacaine with opioids with greater patient satisfaction and significantly reduced side effects.
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- 2018
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19. Changes in cardiac index during labour analgesia: A double-blind randomised controlled trial of epidural versus combined spinal epidural analgesia - A preliminary study
- Author
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Stephanie Yacoubian, Corrina M Oxford, and Bhavani Shankar Kodali
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Cardiac output ,combined spinal epidural ,epidural labour analgesia ,Anesthesiology ,RD78.3-87.3 - Abstract
Background and Aims: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. Methods: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia. The Electrical Cardiometry Monitor ICON® was used to continuously determine maternal CI non-invasively, heart rate (HR) and stroke volume at baseline and up to 60 min after initiation of either intrathecal or epidural analgesia. In addition, maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Results: Both SBP and DBP had a similar, significant decrease following initiation of either epidural or CSE analgesia. However, parturients in the CSE group (n = 10) demonstrated a significant decrease in HR and CI compared to the baseline measurements. On the other hand, the parturients in the E (n = 13) group showed no decreases in either maternal HR or CI. Foetal heart changes were observed in four patients following CSE and one patient following an epidural. Conclusion: Labour analgesia with CSE is associated with a significant decrease in HR and CI when compared to labour analgesia with epidural analgesia. Further studies are necessary to determine whether a decrease in CI diminishes placental blood flow.
- Published
- 2017
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20. Neuraxial Anesthesia for an Open Low Anterior Rectal Resection: Tip the Scales in Patient's Favor.
- Author
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Marrone F, Fusco P, Lepre L, Giulii Capponi M, Villani A, Paventi S, Tomei M, Starnari R, and Pullano C
- Abstract
We present the case of a successful application of combined spinal-epidural anesthesia for a geriatric patient undergoing open cancer surgery. The patient, affected by multiple comorbidities, was proposed for an open anterior rectal resection. The implementation of a tailored protocol, incorporating neuraxial techniques such as epidural and spinal anesthesia, facilitated optimal pain management and expedited postoperative recovery improving perioperative outcomes, and highlighting the potential benefits of such strategies in selected cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Marrone et al.)
- Published
- 2024
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21. Don't stress: a case report of regional anesthesia as the primary anesthetic for gynecologic surgery in a patient with mitochondrial myopathy and possible malignant hyperthermia susceptibility.
- Author
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Pepper, Marci B., Njathi-Ori, Catherine, and Kinney, Michelle Ochs
- Subjects
- *
DIAGNOSIS of muscle diseases , *ANESTHESIA , *CONDUCTION anesthesia , *DISEASE susceptibility , *FENTANYL , *GYNECOLOGIC surgery , *KETAMINE , *MALIGNANT hyperthermia , *MIDAZOLAM , *MUSCLE diseases , *EPIDURAL anesthesia , *DISEASE management , *COMORBIDITY , *TREATMENT effectiveness , *MITOCHONDRIAL myopathy , *DISEASE complications , *DISEASE risk factors - Abstract
Background: We aim to describe the evaluation and management of a patient with the uncommon combination of both mitochondrial myopathy and possible malignant hyperthermia susceptibility as an important source of information and as a valuable example of the role of regional anesthesia for patients with these diagnoses. Case presentation: A 24 year old woman with a history of possible mitochondrial myopathy and possible malignant hyperthermia susceptibility presented for gynecologic surgery. Surgery was well tolerated with combined spinal epidural anesthesia as well as sedation with midazolam, ketamine, and fentanyl. Conclusions: Anesthetic management of patients with mitochondrial myopathy is challenging, made even more so with concurrent malignant hyperthermia susceptibility. This case adds an example to the literature of employing regional anesthesia as a safe approach to this complex care. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
22. Efficacy of epidural dexamethasone combined with intrathecal nalbuphine in lower abdominal oncology operations.
- Author
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Ghanem, Mohamed, Gad, Mona, Abdallah, Ahmed, Shetiwy, Mosab, and Shetiwy, Mohamed
- Subjects
- *
SPINAL infusions , *EPIDURAL injections , *DEXAMETHASONE , *VISCERAL pain , *POSTOPERATIVE pain , *PATIENT satisfaction - Abstract
Background: Dragging pain during lower abdominal surgeries under intrathecal anesthesia is a common problem. Epidural steroid seemed to be effective in reducing intra and postoperative pain. Kappa receptor agonist like nalbuphine helps in reduction of visceral pain. Hence, this study was designed to detect the efficacy of epidural steroid dexamethasone with intrathecal Kappa opioid as a sole anesthetic technique in patients subjected to lower abdominal oncology operations. Patients and Methods: Patients were randomly allocated into two groups; epidural placebo group–control group (Group P) – Intrathecal injection of 20 μg fentanyl followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5%, then (epidural injection placebo 15 mL volume of sterile saline 0.9%). Epidural dexamethasone group–study group (Group D) – Intrathecal injection of 0.6 mg nalbuphine followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5% then (epidural injection of 8 mg dexamethasone in 15 mL total volume using sterile saline 0.9%). Results: Group D recorded significantly longer times to 1st analgesic request, sensory regression to S1 and modified bromage Score 0 with significant lower number of patients that had abdominal dragging pain in comparison with Group P. Visual analog score in the first four postoperative hours, total postoperative nalbuphine dose in 1st 24 h and incidence of nausea and vomiting were significantly lower in Group D. Heart rate and mean arterial pressure were comparable in both groups. Postoperative headache incidence was comparable in both groups. Both patient and surgeon satisfaction were significantly higher in Group D compared to Group P. Conclusion: Combined epidural dexamethasone with intrathecal nalbuphine as a sole anesthetic technique during lower abdominal oncology operations could be an efficient anesthetic technique that offered better block characteristics, with more analgesia and as a result it gained better patient and surgeon satisfaction. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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23. Comparison of Different Volumes of Normal Saline for Epidural Volume Extension in Combined Spinal Epidural Anesthesia for Lower Abdominal Surgeries.
- Author
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Kohli, Anita Vig, Bhat, Kavita, Wakhloo, Renu, and Gulati, Samriti
- Subjects
- *
ABDOMINAL surgery , *SPINAL anesthesia , *EPIDURAL anesthesia , *EPIDURAL catheters , *STATISTICAL software - Abstract
Context: Block augmentation by epidural volume extension has been adequately documented but there have been not enough studies comparing different volumes of normal saline used in this technique to augment the level of block achieved. The study compares different volumes of normal saline(5,10 and 20 ml) for epidural volume extension in combined spinal epidural anaesthesia for lower abdominal surgeries. 120 women, aged between 20-60 years belonging to ASA grade I-II undergoing elective lower abdominal surgeries were included in this study. The patients were randomly allocated into 3 groups and each group comprised of 40 patients. GROUP 1(EVE 5) received 10 mg 0.5% bupivacaine heavy (H) intrathecally with 5 ml normal saline through the epidural catheter as a part of Epidural volume extension. GROUP 2 (EVE10) and GROUP 3 (EVE20) received 10 ml and 20 ml of normal saline as a part of Epidural volume extension respectively in addition to the intrathecal drug. The patients were assessed for sensory block level to loss of pain from pin prick and for motor block using Bromage scale. Peak sensory block height, highest Bromage score, time taken to achieve maximum sensory and motor block and the time to their recovery were recorded. Statstical Analysis. was done using statistical software SSPS version 16.0 and Epi- info version 6.0. Outcome measures were presented as % for qualitative variables and mean±SD for quantitative variables. Demographic data and duration of surgery were similar in all the groups. Sensory block augmentation was found to be significantly higher in the EVE10 and EVE 20 groups. There was no difference in the peak motor block score between the groups during the study. Time to achieve the blocks were significantly shorter for the 20 ml group than the 10 and 5 ml groups; the latter two being comparable. This was associated with a significantly faster motor recovery to Bromage 0 in groups EVE10 and EVE 20. [ABSTRACT FROM AUTHOR]
- Published
- 2019
24. Neuraxial analgesia in labour – induction and maintenance.
- Author
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Summers, Brynmor A. and Flett, Graeme G.
- Abstract
Since the introduction of epidurals for labour analgesia in 1946 it has become the gold standard on delivery units throughout the world. Controversy remains as to the effects of neuraxial block upon the fetus; however, it is now widely accepted that there are beneficial and not just detrimental effects. With the introduction of low-dose anaesthetic solutions the major cardiovascular effects and concerns with toxicity have become much less prominent and the lack of profound motor block associated with traditional dosing has resulted in greater maternal satisfaction, although not the mobile revolution which was once anticipated. As research continues to search for the ideal labour analgesia, newer technologies are evolving making epidurals ever safer, individualized and tailored to the modern women in the delivery suite, as they demand greater control and autonomy over their deliveries. No current method has been able to emulate these ideals, but in the mean time women can enjoy safe and effective analgesia with minimal risks to either themselves or their babies. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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25. How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option.
- Author
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Gunaydin, Berrin and Erel, Selin
- Subjects
- *
LABOR pain (Obstetrics) , *PAIN management , *LOCAL anesthetics , *EPIDURAL analgesia , *CEREBROSPINAL fluid - Abstract
Background and aim: Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population. The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literatureDiscussion: Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural.Conclusion: DPE offers a favorable risk-benefit ratio for management of neuraxial analgesia as a novel option. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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26. What’s New in Neuraxial Labor Analgesia
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Toledano, Roulhac D. and Leffert, Lisa
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- 2021
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27. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know
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Ihab Kamel, Muhammad F Ahmed, and Anish Sethi
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Neuraxial blocks ,Femoral ,Sciatic ,Nerve injury ,Upper extremity ,iPACK ,Spinal ,Adductor canal ,Regional anesthesia ,Review ,Fascia iliaca ,Infraclavicular ,Combined spinal epidural ,Orthopedics and Sports Medicine ,Popliteal ,Brachial plexus ,Saphenous ,Orthopedic surgery ,Supraclavicular ,Lower extremity ,Local anesthetic systemic toxicity ,Axillary ,Peripheral nerve blocks ,Continuous nerve block catheters ,Block failure ,Epidural ,Lumbar plexus ,Ankle ,Interscalene ,Complication - Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
- Published
- 2022
28. Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour
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Nejc Umek, Iva Blajic, Miha Lucovnik, Neli Semrl, Tea Zagar, and Tatjana Stopar Pintaric
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medicine.medical_treatment ,Analgesic ,Remifentanil ,Pregnancy ,medicine ,Humans ,Adverse effect ,Pain Measurement ,Labor Pain ,Analgesics ,business.industry ,Patient-controlled analgesia ,Infant, Newborn ,Obstetrics and Gynecology ,Analgesia, Patient-Controlled ,University hospital ,medicine.disease ,Hypoventilation ,Analgesia, Epidural ,Analgesics, Opioid ,Combined spinal epidural ,Patient Satisfaction ,Anesthesia ,Analgesia, Obstetrical ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA.A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017-2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared.CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5-5] vs 5 [4-5], p0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (8). None had umbilical artery pH7.0.In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation.
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- 2021
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29. Update on Modalities and Techniques for Labor Epidural Analgesia and Anesthesia.
- Author
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Chau, Anthony and Tsen, Lawrence C.
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ANALGESIA ,ANESTHESIA in obstetrics ,BRADYCARDIA ,CATHETERS ,LABOR (Obstetrics) ,SPINAL anesthesia ,LUMBAR puncture ,UTERINE contraction ,EPIDURAL analgesia ,PREGNANCY - Published
- 2018
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30. An observational study to evaluate the effect of different epidural analgesia regimens on dynamic pain scores in patients receiving epidural analgesia for postoperative pain relief after elective gynecological surgery.
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Singh, Manpreet, Singh, Ranju, and Jain, Aruna
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- *
EPIDURAL analgesia , *POSTOPERATIVE pain , *GYNECOLOGIC surgery , *ANALGESIA , *HUMAN experimentation - Abstract
Background and Aims: The primary measure of efficacy of any analgesic regimen is pain relief, but it is important to measure dynamic pain relief rather than pain relief at rest. Epidural analgesia is an effective technique for postoperative analgesia. The drug combinations given therein (local anesthetics with adjuvants such as opioids/alpha-2 agonists), however, remain a personal choice. The aim of this study was to evaluate dynamic pain scores in patients receiving different epidural analgesia regimens for postoperative pain relief after elective gynecological surgery used in our institution. Material and Methods: One hundred eighty-seven patients enrolled in this study received postoperatively either bupivacaine 0.125% + morphine 0.1 mg/mL (group BM) or bupivacaine 0.125% + fentanyl 2 μg/mL (group BF) or bupivacaine 0.125% + clonidine 1 μg/mL (group C1) or bupivacaine 0.125% + clonidine 2 μg/mL (group C2) by continuous epidural infusion @ 5 mL/h. Differences in dynamic pain scores (on coughing and mobilization), pain scores at rest, sensory and motor blockade, sedation scores, dry mouth, pruritus, nausea, and vomiting were recorded. Also duration of postoperative analgesia, epidural top-ups, requirement of rescue analgesic, and patient satisfaction were determined. All observations were carried out at 1, 2, 4, 8, and 12 h after surgery and then at 8 am, 12 noon, 4 pm, 8 pm on subsequent postoperative day till removal of epidural catheter (after 96 h). Results: There was no difference in demographic or hemodynamic profile among the four groups (P > 0.05). There was no statistically significant difference in pain scores at rest among the four groups but dynamic pain scores were found to be better in group C2 as compared to group BM, BF, and C1 at most of the time intervals although not statistically significant (P > 0.05). Requirement of rescue analgesics was lower in group BM and group C2 as compared to group BF and C1 (P < 0.01). Incidence of pruritus was 43.5% in group BM and 19% in group BF, while no patients in group C1 or C2 had pruritus. Mean postoperative nausea and vomiting (PONV) scores were higher in group BM and group BF as compared to group C1 and C2 (P < 0.001). Mean sedation scores were comparable in all four groups. Incidence of dry mouth was 22% in group C2 as compared to 11% in group C1, while no patients in group BM or BF had dry mouth. Patients in group C2 were more satisfied as compared to other three groups. Conclusions: Combination of clonidine 2 μg/mL to 0.125% bupivacaine @ 5 mL/h in combined spinal epidural provides better postoperative analgesia as compared to combination of bupivacaine with opioids with greater patient satisfaction and significantly reduced side effects. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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31. Anesthetic management of mosaic Turner's syndrome posted for elective cesarean delivery after spontaneous pregnancy.
- Author
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Kalopita, K., Michala, L., Theofanakis, C., and Valsamidis, D.
- Abstract
Turner's syndrome, one of the most common sex chromosome abnormalities in females, is caused by loss of part or all of an X chromosome. We report a case of mosaic Turner's syndrome, posted for elective cesarean delivery under low-dose sequential combined spinal-epidural anesthesia. The unique features of this case were the combination of an anticipated difficult airway and both short stature and scoliosis in the lumbar region. A titrated combined spinal-epidural technique was performed in order to avoid hemodynamic instability, which could have been exacerbated in the presence of cardiovascular deformities that accompany this syndrome in many cases. The patient was managed successfully under regional anesthesia, which is generally a preferred technique to general anesthesia, to avoid sympathetic stimulation during intubation and emergence. Further, this technique may avoid potential complications associated with difficult airway management. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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32. Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients: a randomized controlled trial
- Author
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Wei Chen, Zhiqiang Liu, Zhendong Xu, Yilu Zhou, Yiyi Tao, and Shuangqiong Zhou
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Adult ,Anesthesia, Epidural ,Combined spinal epidural anesthesia ,Anesthesia, Spinal ,law.invention ,Patient satisfaction ,Randomized controlled trial ,law ,Pregnancy ,Ultrasound ,Medicine ,Humans ,Obesity ,Cesarean delivery ,Ultrasonography ,Labor, Obstetric ,Elective cesarean section ,business.industry ,Cesarean Section ,Incidence (epidemiology) ,Research ,General Medicine ,Different approaches ,Clinical trial ,Combined spinal epidural ,Anesthesia ,Female ,business ,Obese patients - Abstract
Background Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound. Methods One hundred obese patients (BMI ≥ 30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First-attempt success rate, the median positioning time and total operation time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, anesthesia adverse reactions, complications after anesthesia, and patients’ satisfaction with the epidural puncture were recorded. Results The first-attempt success rate was significantly different between the two groups [92% (46/50) vs. 76% (38/50), P = 0.029]. The median positioning time and total operation time in the paramedian approach group were higher than those in the median approach group (227.7 s vs. 201.6 s, P = 0.037; 251.3 s vs. 247.4 s, P = 0.145). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs. 12%, P = 0.026), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P = 0.032). Conclusion The ultrasound-guided paramedian approach for CSEA is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction. Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019
- Published
- 2021
33. An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal–epidural anesthesia: a retrospective study
- Author
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Yuya Murata, Kumiko Yamada, Makoto Tanaka, Soichiro Yamashita, and Yuto Hamaguchi
- Subjects
Weakness ,medicine.medical_specialty ,Numbness ,Analgesic ,Obstetric anesthesia ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,Combined spinal–epidural anesthesia ,0302 clinical medicine ,030202 anesthesiology ,Anesthesiology ,Medicine ,Clinical Research Article ,Motor weakness ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Retrospective cohort study ,lcsh:RC86-88.9 ,Epidural catheter ,Anesthesiology and Pain Medicine ,Combined spinal epidural ,Patient-controlled epidural analgesia ,lcsh:Anesthesiology ,Anesthesia ,medicine.symptom ,business ,Catheter placement - Abstract
Background Epidural anesthesia affects lower extremities, which often prevents early mobilization postoperatively. The incidence of numbness and motor weakness in the lower extremities with respect to epidural catheter placement site in cesarean section (CS) is uncertain. We aimed to investigate the effect of catheter placement site on postoperative lower extremities numbness and motor weakness in patients who received combined spinal–epidural anesthesia (CSEA) for CS including analgesic effects and optimal epidural placement site in CS. Methods We retrospectively included 205 patients who underwent CS with CSEA at the University of Tsukuba Hospital between April 2018 and March 2020, and assessed numbness and motor weakness in the lower extremities. We also examined whether differences in the intervertebral space of epidural catheter placement and epidural effect on the lower extremities are related to analgesic effects. ANOVA and Mann–Whitney U test were used for statistical analysis. Results The incidence of numbness and motor weakness were 67 (33%) and 28 (14%), respectively. All patients with motor weakness had numbness. A more caudal placement was associated with increased incidence of affected lower extremities. There was no significant difference in the analgesic effect depending on the catheter placement site. When the lower extremities were affected, the number of additional analgesics increased (p < 0.001). Patient-controlled epidural analgesia was used for fewer days in patients with motor weakness (p = 0.046). Conclusion In CS, epidural catheter placement at T10–11 or T11–12 interspace is expected to reduce effect on the lower extremities and improve quality of postoperative analgesia.
- Published
- 2021
34. Use of combined spinal-epidural anesthesia in gynecological simultaneous operations
- Author
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Jasur Tolibovich Yusupov, Shukur Kuylievich Pardaev, and Isroil Latipovich Sharipov
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Norepinephrine (medication) ,Excretion ,Combined spinal epidural ,business.industry ,Anesthesia ,Respiration ,Medicine ,Hemodynamics ,sense organs ,General Medicine ,business ,medicine.drug - Abstract
The effectiveness of combined spinal-epidural anesthesia in gynecological simultaneous operations was studied in 65 patients. The average age of the patients was 51,56 years. The parameters of external respiration, hemodynamics, norepinephrine excretion, and changes in cortisol concentration were studied. The use of CSEA has a pronounced protective effect against surgical trauma and associated adverse neurohumoral, hemodynamic, and biochemical changes.
- Published
- 2021
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35. A prospective study evaluating the effectiveness of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb orthopedic surgeries using low dose intrathecal hyperbaric bupivacaine.
- Author
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Sudhakaran, S. and Ashwini, S.
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- *
SPINAL anesthesia , *DRUG efficacy , *ORTHOPEDIC surgery - Abstract
Background: Combined spinal-epidural anesthesia technique for providing pain relief for orthopedic procedures has gained popularity. It combines the advantages of rapid onset and the reliability of blockade obtained spinally along with the flexibility given by epidural catheter avoiding the disadvantages of either technique used alone. Spinal anesthesia provides dense neural blockade of finite duration while epidural is more titratable producing less hemodynamic swings and postoperative analgesia. The epidural volume extension adds color to combined spinal-epidural anesthesia technique where the onset and the level of blockade obtained spinally are enhanced by administering saline or local anesthetic via the epidural catheter. The ideology behind this is the volume effect accomplished by injecting saline epidurally which would result in intrathecal compression and cephalad migration of spinal local anesthetic. Aim of the study: To identify the effectiveness of block profile provided by extending the epidural volume with normal saline for lower limb orthopedic surgeries using a low dose intrathecal hyperbaric bupivacaine without causing hemodynamic changes. Materials and methods: A prospective randomised controlled study involving 80 patients posted for elective lower limb orthopedic surgeries were divided into two groups of 40 each. Group A received combined spinal-epidural anesthesia with 10 mg of 0.5% bupivacaine with epidural volume extension of 10 ml normal saline. Group B received combined spinal-epidural anesthesia alone. The blood pressure and heart rate changes were observed at the 5th, 10th, 15th, 20th min and then every fifteen minutes. Results: Low dose of intrathecal hyperbaric bupivacaine (10 mg) with 25 micrograms of fentanyl with epidural volume extension (10ml normal saline) is associated with early onset of sensory and motor blockade, high level of sensory block, shorter time of two segment regression. Conclusion: In this study we can safely conclude that combination of spinal epidural with epidural volume extension with normal saline achieves an effective and shorter block time as evident by significantly lower maximum motor block time providing prolonged analgesia by requiring less topup dose of bupivacaine with higher level of sensory block at the tenth minute with shorter mean maximum sensory block time. [ABSTRACT FROM AUTHOR]
- Published
- 2017
36. Changes in cardiac index during labour analgesia: A double-blind randomised controlled trial of epidural versus combined spinal epidural analgesia - A preliminary study.
- Author
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Yacoubian, Stephanie, Oxford, Corrina M., and Kodali, Bhavani Shankar
- Subjects
- *
LABOR , *EPIDURAL analgesia , *BRADYCARDIA , *ETIOLOGY of diseases , *HEART beat - Abstract
Background and Aims: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. Methods: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia. The Electrical Cardiometry Monitor ICON® was used to continuously determine maternal CI non-invasively, heart rate (HR) and stroke volume at baseline and up to 60 min after initiation of either intrathecal or epidural analgesia. In addition, maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Results: Both SBP and DBP had a similar, significant decrease following initiation of either epidural or CSE analgesia. However, parturients in the CSE group (n = 10) demonstrated a significant decrease in HR and CI compared to the baseline measurements. On the other hand, the parturients in the E (n = 13) group showed no decreases in either maternal HR or CI. Foetal heart changes were observed in four patients following CSE and one patient following an epidural. Conclusion: Labour analgesia with CSE is associated with a significant decrease in HR and CI when compared to labour analgesia with epidural analgesia. Further studies are necessary to determine whether a decrease in CI diminishes placental blood flow. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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37. Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia
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Deepti Saigal and Rama Wason
- Subjects
Combined spinal epidural ,double segment ,needle through needle ,paramedian ,Anesthesiology ,RD78.3-87.3 - Abstract
Background: Although different techniques have been developed for administering combined spinal epidural (CSE) anaesthesia, none can be described as an ideal one. Objectives: We performed a study to compare two popular CSE techniques: Double segment technique (DST) and single segment (needle through needle) technique (SST) with another alternative technique: Paramedian epidural and midline spinal in the same intervertebral space (single space dual needle technique: SDT). Methods: After institutional ethical clearance, 90 consenting patients undergoing elective lower limb orthopaedic surgery were allocated to receive CSE into one of the three groups (n=30 each): Group I: SST, Group II: SDT, Group III: DST using computerized randomization. The time for technique performance, surgical readiness, technical aspects of epidural and subarachnoid block (SAB) and morbidity were compared. Results: SDT is comparable with SST and DST in time for technique performance (13.42±2.848 min, 12.18±6.092 min, 11.63±3.243 min respectively; P=0.268), time to surgical readiness (18.28±3.624 min, 17.64±5.877 min, 16.87±3.137 min respectively; P=0.42) and incidence of technically perfect block (70%, 66.66%, 76.66%; respectively P=0.757). Use of paramedian route for epidural catheterization in SDT group decreases complications and facilitates catheter insertion. There was a significant number of cases with lack of dural puncture appreciation (SST=ten, none in SDT and DST; P=0.001) and delayed cerebrospinal fluid reflux (SST=five, none in SDT and DST; P=0.005) while performance of SAB in SST group. The incidence of nausea, vomiting, post-operative backache and headache was comparable between the three groups. Conclusion: SDT is an acceptable alternative to DST and SST.
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- 2013
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38. Sequential Combined Spinal-epidural Anesthesia in a Multiple Comorbidity Patient: An Indispensable Tool in Anesthesiologists’ Armamentarium
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Vishwadeep Singh, Geeta Karki, Akhilesh Pahade, and Ashita Mowar
- Subjects
musculoskeletal diseases ,Ejection fraction ,pulmonary fibrosis ,business.industry ,Case Report ,Osteoarthritis ,postoperative analgesia ,medicine.disease ,musculoskeletal system ,Comorbidity ,Coronary artery disease ,Combined spinal epidural ,Anesthesia ,Pulmonary fibrosis ,Materials Chemistry ,medicine ,Performed Procedure ,sequential spinal epidural ,Augment ,business - Abstract
Primary total knee joint arthroplasty (TKA) is a frequently performed procedure as part of osteoarthritis treatment. Optimal perioperative analgesia will augment functional recovery, improve knee mobility, and reduce postoperative morbidity. Octa- and nonagenarians undergoing TKA are often considered particularly difficult to manage and involve high levels of competence due to associated comorbidities these patients present with. We report a case of a geriatric patient with coronary artery disease and low ejection fraction with pulmonary fibrosis who underwent successful total knee arthroplasty under sequential combined spinal-epidural anesthesia.
- Published
- 2021
39. Intrinsic Obstetric Palsy: Case Report and Literature Review
- Author
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Rashida Hakeem and Cliff Neppe
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ambulatory analgesia ,combined spinal epidural ,epidural ,low dose infusion ,postpartum ,Medicine - Abstract
Maternal neurological injuries may be intrinsic to the labour and delivery process or may result directly or indirectly from obstetric or anaesthetic intervention. This intrinsic obstetric palsy is a rare complication of labour but can have devastating impact on a previously healthy mother. A 23-year-old gravida1, para0 who had epidural for labour analgesia, was augmented for slow progress and had a normal vaginal delivery. She was diagnosed post delivery with intrinsic obstetric palsy involving several peripheral nerves and lumbosacral nerve roots with a guarded prognosis. In this article we have discussed the risk factors and mechanisms of intrinsic obstetric palsy and proposed further investigation into the potential protective role of ambulatory analgesia i.e. CSE (Combined Spinal Epidural) or LDI (Low Dose Infusion).
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- 2016
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40. Comparison of epidural technique with combined spinal epidural technique for labor analgesia
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Dhaval Kumar C. Patel and Neeta Abhay Kavishvar
- Subjects
Bupivacaine ,business.industry ,medicine.medical_treatment ,Intrathecal ,law.invention ,Fentanyl ,Combined spinal epidural ,Bolus (medicine) ,Randomized controlled trial ,law ,Anesthesia ,medicine ,Airway management ,Labor analgesia ,business ,medicine.drug - Abstract
Introduction: For pain relief during labor, regional analgesia is considered the most preferred technique; nevertheless the best method is yet to be determined. We carried out a randomized study to assess efficacy, safety & maternal satisfaction with standard epidural and combined spinal epidural (CSE) analgesia technique among 40 primigarvida. Materials and Methods: Healthy primigarvida in labor having cervical dilatation between 3 to 5 cm were assigned randomly to receive either epidural or CSE for labor analgesia. Analgesia was established in Epidural group with 12ml of 0.0625% bupivacaine added with 2µg/ml fentanyl & in CSE group with intrathecal injection of 2.5mg 0.5% heavy bupivacaine plus fentanyl 25µg (total 2 ml). In both groups whenever patient’s VAS>3, 2nd dose was given in form of epidural bolus 10ml 0.0625% bupivacaine + 2µg/ml fentanyl, followed by infusion of same concentration at 8 ml/h. Results: The onset of labor analgesia was significantly faster in CSE group (5.5±1.9 vs. 13±5.9 minutes, p
- Published
- 2020
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41. Effects of different epidural initiation volumes on postoperative analgesia in cesarean section
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Nurçin Gülhaş, Gulay Erdogan Kayhan, Osman Kaçmaz, and Mahmut Durmuş
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combined spinal epidural anesthesia ,Adult ,Adolescent ,Visual analogue scale ,Postoperative pain ,Analgesic ,030204 cardiovascular system & hematology ,Article ,patient-controlled epidural analgesia ,Fentanyl ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Double-Blind Method ,Pregnancy ,medicine ,Humans ,Anesthetics, Local ,Bupivacaine ,0303 health sciences ,Pain, Postoperative ,Study drug ,Dose-Response Relationship, Drug ,030306 microbiology ,business.industry ,Cesarean Section ,Analgesia, Patient-Controlled ,General Medicine ,Middle Aged ,Analgesia, Epidural ,Analgesics, Opioid ,Epidural catheter ,Combined spinal epidural ,Treatment Outcome ,Anesthesia ,Female ,business ,postoperative pain ,medicine.drug - Abstract
Background/aim The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections. Materials and methods Eighty-one pregnant women, aged 18–45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 μg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively. Results There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.
- Published
- 2020
42. COMPARISON OF EFFICACY OF COMBINED SPINAL-EPIDURAL ANAESTHESIA WITH GENERAL ANAESTHESIA IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY
- Author
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Sunny Kumar, ijar, and Kalpana Kulkarni
- Subjects
Combined spinal epidural ,business.industry ,Anesthesia ,Medicine ,In patient ,General anaesthesia ,business ,Laparoscopic cholecystectomy - Published
- 2020
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43. Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study
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Hitomi Ando, Shuko Nojiri, Yojiro Maruyama, Jun Takeda, Atsuo Itakura, Hiroyuki Sumikura, and Shintaro Makino
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Adult ,medicine.medical_specialty ,Combined-spinal epidural analgesia ,Cervical dilation ,Reproductive medicine ,Anesthesia, Spinal ,lcsh:Gynecology and obstetrics ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,parasitic diseases ,Humans ,Medicine ,Fetal head ,030212 general & internal medicine ,Cervix ,reproductive and urinary physiology ,Vaginal delivery ,lcsh:RG1-991 ,Retrospective Studies ,Fetal Station ,Labor, Obstetric ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,Primiparous ,Analgesia, Epidural ,Parity ,Combined spinal epidural ,medicine.anatomical_structure ,Anesthesia ,Neuraxial labor analgesia ,Analgesia, Obstetrical ,Female ,Labor curve ,Labor management ,business ,Research Article - Abstract
Background Neuraxial labor analgesia is known to increase the rate of instrumental delivery and prolong the second stage of labor; however, there is no standard method to evaluate the progress of labor under analgesia. Friedman curve is considered the gold standard for evaluating the progress of labor. However, it included not only neuraxial labor analgesia but also labor without analgesia. Thus we compared the labor curves of primiparous women undergoing labor with and without neuraxial labor analgesia, to understand the progress of labor in both groups and to arrive at a standard curve to monitor the progress of labor under neuraxial analgesia. Methods Primiparous women with cephalic singleton pregnancies who delivered at term from 2016 to 2017 were included. Two hundred patients who opted for combined spinal-epidural (CSE) labor analgesia were included in the CSE group and 200 patients who did not undergo CSE were included in the non-CSE group. In all, 400 cases were examined retrospectively. The evaluation parameters were cervical dilation and fetal station, and we calculated the average value per hour to plot the labor curves. Results The labor curve of the non-CSE group was significantly different from the Friedman curve. In the CSE group, the time from 4 cm dilation of the cervix to full dilation was 15 h; in addition, the speed of cervical dilation was different from that in the non-CSE group. The progress of labor in the CSE group was faster than that in the non-CSE group during the latent phase; however, the progress in the CSE group was slower than that in the non-CSE group during the active phase. Conclusions Neuraxial labor analgesia results in early cervical dilation and descent of the fetal head; thus, appropriate advance planning to manage the delivery may be essential.
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44. COMBINED SPINAL EPIDURAL ANAESTHESIA VERSUS EPIDURAL ANAESTHESIA: A COMPARATIVE STUDY
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Bipin Karki, Roshana Amatya, Anil Shrestha, Pramesh Sunder Shrestha, Bigen Man Shakya, and Ninadini Shrestha
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Bupivacaine ,Epidural catheter ,Catheter ,Combined spinal epidural ,business.industry ,Anesthesia ,Epidural block ,medicine ,Mann–Whitney U test ,Hemodynamics ,Regional anaesthesia ,business ,medicine.drug - Abstract
Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Combined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epidural anaesthesia. Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly divided into 2 groups. Group A patients received CSEA using “double needle double interspace technique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subsequent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Chi-square test where appropriate and the Statistical Analysis was done using SPSS program, version 11.0. Results: The surgical anaesthesia and motor blockade occurred significantly early in CSEA group. Duration of analgesia was significantly shorter in CSEA (84.1±40.6 min) as compared to epidural group (138.6±32.9 min). The total amount of bupivacaine required to attain the same target level was two times in epidural group (p
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45. Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations
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Emilia Guasch, Fernando Gilsanz, and Nicolas Brogly
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Epidural Space ,medicine.medical_treatment ,Neuraxial blockade ,Anesthesia, Spinal ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030202 anesthesiology ,parasitic diseases ,Anesthesia, Obstetrical ,Humans ,Medicine ,Caesarean section ,030212 general & internal medicine ,Cesarean Section ,business.industry ,medicine.disease ,Anesthetics, Combined ,Epidural space ,Analgesia, Epidural ,Labour analgesia ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Combined spinal epidural ,Maternal Hypotension ,External cephalic version ,Anesthesia ,Analgesia, Obstetrical ,Female ,business - Abstract
Purpose of review Even if its use is scarce in most countries, many articles concerning combined spinal epidural (CSE) were published. In this review, we present the latest advances concerning CSE in obstetrics. Recent findings During labour, CSE improves epidural analgesia quality. Epidural with intradural opioids can produce maternal hypotension and foetal heart rate abnormalities (FHR-Ab), without increasing the caesarean section rate. For caesarean section, CSE decreases the neuraxial block failure rate, with no significant increase of complications. Epidural volume extension (EVE) after CSE for caesarean section could be an interesting option even though more evidence is needed. Summary For labour analgesia, CSE has the fastest onset time of analgesia. Its side effects have no consequences on maternal, labour or foetal outcomes. It provides better analgesia than epidural analgesia and can be used for external cephalic version and high-risk patients. For caesarean section, CSE has become the reference neuraxial technique for low-dose spinal anaesthesia, with higher success rate compared with regular spinal anaesthesia. Recent systematic revisions did not confirm this superiority. CSE offers the advantage of EVE, intraoperative top-ups, postoperative administration of neuraxial opioids and local anaesthetics. The risk of complications is balanced by the benefits of the technique.
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46. Recurrent Abducens Nerve Palsy, and Hypoglossus Nerve Palsy after Combined Spinal-Epidural Anesthesia for Cesarean Section
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Lutfiye Pirbudak
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Palsy ,Combined spinal epidural ,business.industry ,Anesthesia ,Section (typography) ,Medicine ,Nerve palsy ,business ,Abducens nerve - Published
- 2020
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47. A randomised double-blind dose–response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal–epidural anaesthesia for Caesarean delivery
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Fei Xiao, Feng Fu, Warwick D. Ngan Kee, Yanhong Zhou, Xinzhong Chen, Meijuan Yang, and Wending Chen
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Adult ,Anesthesia, Epidural ,Caesarean delivery ,Blood Pressure ,Anesthesia, Spinal ,law.invention ,Norepinephrine ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Pregnancy ,030202 anesthesiology ,law ,Anesthesia, Obstetrical ,Humans ,Medicine ,Dosing ,ED50 ,Dose-Response Relationship, Drug ,Cesarean Section ,business.industry ,Spinal anesthesia ,Effective dose (pharmacology) ,Clinical trial ,Anesthesiology and Pain Medicine ,Combined spinal epidural ,Anesthesia ,Female ,Hypotension ,business - Abstract
Background Norepinephrine infusion has been suggested as an effective method for preventing hypotension during spinal anaesthesia for Caesarean delivery. However, optimal dosing regimens for norepinephrine have not been well established. This study aimed to determine the dose–response characteristics of a weight-adjusted fixed-rate infusion of norepinephrine to prevent hypotension during neuraxial anaesthesia for Caesarean delivery. Methods In a double-blind, randomised controlled trial, 80 parturients having elective Caesarean delivery received a prophylactic norepinephrine infusion at 0.025 μg kg−1 min−1 (Group N1), 0.05 μg kg−1 min−1 (Group N2), 0.075 μg kg−1 min−1 (Group N3), or 0.10 μg kg−1 min−1 (Group N4), starting immediately after induction of combined spinal–epidural anaesthesia. The primary outcome was non-occurrence of hypotension, defined as a decrease in systolic arterial pressure ≥20% below baseline value or to ≤90 mm Hg, before delivery. Values for 50% effective dose (ED50) and ED90 were calculated using probit regression. Results The incidence of hypotension was 11/20 (55%), 6/20 (30%), 2/20 (10%), and 1/20 (5%) in Groups N1, N2, N3, and N4, respectively (P Conclusions Under the conditions of this study, an infusion of norepinephrine 0.08 μg kg−1 min−1 was effective for preventing hypotension in 90% of patients. This information should provide a guide for initiating norepinephrine infusions. Clinical trial registration ChiCTR1900022322 at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enindex.aspx).
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48. Comparative study between sequential combined spinal epidural anesthesia versus epidural volume extension in lower limb surgery
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Karim Youssef Kamal Hakim
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medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Hemodynamics ,lcsh:RD78.3-87.3 ,medicine ,Prospective cohort study ,Saline ,Bupivacaine ,Local anesthetic ,business.industry ,Sequential combined spinal epidural anesthesia ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,General Medicine ,lcsh:RC86-88.9 ,Epidural space ,Surgery ,Combined spinal epidural ,medicine.anatomical_structure ,lcsh:Anesthesiology ,Anesthesia ,Orthopedic surgery ,Epidural volume extension ,Spinal anesthesia ,business ,medicine.drug - Abstract
Background This randomized, double-blind study was designed to compare between sequential combined spinal epidural anesthesia versus epidural volume extension in lower limb surgery as regards hemodynamics, sensory, and motor blocks. Methods In this randomized, double-blind, prospective study, 80 patients scheduled for lower limb surgery were divided into two groups: sequential combined spinal epidural (SCSE) group in which small doses of local anesthetic was injected in epidural space after low-dose spinal anesthesia and epidural volume extension (EVE) group in which 10 ml saline was injected in epidural space after low-dose spinal anesthesia. Hemodynamics, anesthesia readiness time, degree of motor block, time to regression of sensory block, and side effects were measured. Results Hemodynamic changes were insignificant. Anesthesia readiness time was significantly faster in EVE group. Motor block and sensory block were better in SCSE. Postoperative bupivacaine consumption was statistically insignificant between the two groups. Conclusion Both SCSE and EVE techniques can preserve hemodynamics after low-dose subarachnoid block and can be used in high-risk elderly patients undergoing orthopedic surgery.
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49. Modification of combined spinal-epidural analgesia in labor
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Pismensky S.V. Pismensky, Baev O.R. Baev, Pyregov A.V. Pyregov, Perevarova Yu.S. Perevarova, and Tysyachnyi O.V. Tysyachnyi
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Combined spinal epidural ,business.industry ,Anesthesia ,Medicine ,General Medicine ,business - Published
- 2020
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50. The effect of combined spinal epidural versus epidural analgesia on fetal heart rate in laboring patients at risk for uteroplacental insufficiency
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Erin Maetzold, Donna S. Lambers, Mounira Habli, and C. Ganga Devaiah
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Fetal heart ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030202 anesthesiology ,030225 pediatrics ,medicine ,Humans ,Chronic hypertension ,Retrospective Studies ,Labor, Obstetric ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Heart Rate, Fetal ,medicine.disease ,Analgesia, Epidural ,Fetal heart rate ,Combined spinal epidural ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Analgesia, Obstetrical ,Female ,business - Abstract
The effects of neuraxial analgesia on fetal heart tracings have been studied in "healthy" pregnancies. Our objective was to compare the impact of intrapartum epidural analgesia (EA) versus combined spinal epidural analgesia (CSE) on fetal heart rate changes in pregnancies at risk for uteroplacental insufficiency (UPI).Singleton pregnancies diagnosed with chronic hypertension, gestational hypertension and/or preeclampsia, and/or fetal growth restriction (FGR) and receiving neuraxial analgesia intrapartum from 2012 to 2015 were studied retrospectively. The primary outcome was change in fetal heart rate (FHR) category following neuraxial analgesia. Manual review of all FHR tracings was performed and classified by the National Institute of Child Health and Human Development (NICHD) categories. Data collection included maternal demographics, blood pressure, uterine tachysystole, uterine hypertonus, mode of delivery, interventions for FHR abnormalities and neonatal outcomes.Of laboring patients at risk for UPI, 110 patients received EA and 127 patients received CSE. The rate and change in FHR categories and abnormalities following neuraxial analgesia were the same in both groups. Both EA and CSE resulted in a significant increase in NICHD FHR category II, from 27.3 to 65.5% for EA and 20.9 to 64.3% for CSE. The occurrence of maternal hypotension, uterine tachysystole, interventions for FHR abnormalities, and uterine hypertonus following neuraxial analgesia was not found to be significantly different between the two groups. When compared to the EA group, CSE had a higher rate of NICU admission (29.5 versus 16.4%,FHR category increased following both CSE and EA. The side effects of maternal hypotension and need for fetal interventions was not different between CSE and EA.
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- 2020
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