Search

Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia. Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor analgesia and were converted to cesarean delivery at Beijing Tiantan Hospital. According to the anesthesia method of cesarean section, the participants were divided into the epidural anesthesia(EA) group and the subarachnoid anesthesia(SA) group. That were aimed to compare the effects of the two anesthesia methods on the mother and fetus perioperatively. Results Compared with women in the epidural anesthesia group, women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale (VAS) scores, frequency (%)[VAS scores 0-3: 5(25%) vs. 14(70%); VAS scores 4-6: 12(60%) vs. 6(30%); and VAS scores 7-10: 3(15%) vs. 6(30%)], and higher perioperative complication rate. There was nonsignificance difference in perio- perative maternal bleeding, neonatal Apgar score, and neonatal umbilical artery blood gas analysis between the two groups. Conclusions In women with epidural analgesia undergoing cesarean section, the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia. The anesthesiologist must pay attention to prevent complications in the perioperative period.

Abstract Background The efficacy of neuraxial analgesia varies with spinal canal pathology. Notably, a secondary epidural catheter has been shown to increase neuraxial labor analgesia in women with spinal lesions. Therefore, we present a case in which catheter withdrawal played a critical role in achieving effective labor analgesia in a woman with epidural adhesions after lumbar discectomy who had inadequate analgesia with two epidural catheters. Case presentation We encountered a patient with L5 lumbar epidural adhesions who reported pain even after receiving two epidural catheters. The catheters were placed in the L1/2 and L5/S intervertebral spaces. Analgesic effects were exerted when the L5/S catheter was withdrawn by 1 cm, suggesting that the catheter tip was initially placed inside the adhesion. Conclusions Careful consideration of catheter placement and adjustments by withdrawing the catheter are crucial in managing labor analgesia in patients with known epidural adhesions.

Background: The efficacy of neuraxial analgesia varies with spinal canal pathology. Notably, a secondary epidural catheter has been shown to increase neuraxial labor analgesia in women with spinal lesions. Therefore, we present a case in which catheter withdrawal played a critical role in achieving effective labor analgesia in a woman with epidural adhesions after lumbar discectomy who had inadequate analgesia with two epidural catheters. Case presentation: We encountered a patient with L5 lumbar epidural adhesions who reported pain even after receiving two epidural catheters. The catheters were placed in the L1/2 and L5/S intervertebral spaces. Analgesic effects were exerted when the L5/S catheter was withdrawn by 1 cm, suggesting that the catheter tip was initially placed inside the adhesion. Conclusions: Careful consideration of catheter placement and adjustments by withdrawing the catheter are crucial in managing labor analgesia in patients with known epidural adhesions. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of the duration of epidural labor analgesia on the effect of epidural anesthesia during intrapartum cesarean section. Methods A prospective cohort study was conducted to collect and analyze the clinical data of women who were transferred to cesarean section after epidural labor analgesia in the delivery room of the Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region from January 2020 to June 2022. According to the implementation time of labor analgesia the cut-off value of 8 hours as the cut-off value, <8 hours as the short-term group, >8 hours as the long-term group. All of them were given drugs through epidural catheter inserted during labor analgesia during the transfer to cesarean section. Routine first give 3 mL of 1.5% lidocaine as the experimental dose. After the onset of effect, 10-15 mL of 1 % lidocaine and 0.75 % ropivacaine mixture was given for epidural anesthesia, and compare the effects and failure rate of epidural anesthesia between the two groups. Results A total of 56 parturients were included, including 26 in the short-term group and 30 in the long-term group. Five cases of epidural anesthesia failure in the long-term group. The failure rate of long-term group was significantly higher than that in the short-term group(16. 7% vs. 0), and the dosage of delivery analgesic solution of other parturients in the short-term group was significantly less than that in the long-term group [(45. 22±5. 35)mL vs. (80. 15± 10. 50)mL], the differences were statistically significant(P <0.05). There were no significant differences in the total amount of local anesthetic used in cesarean section in the two groups [(15. 18±2. 52)mL vs. (14. 38±1. 05)mL], the time from medication dose to skin incision[(22. 05±8. 42)min vs. (23. 45±6. 87) min], the operation time [(88. 75±21.72)min vs. (85. 10±13.22)min] between the two groups. There were no maternal and neonatal adverse events in the two groups. the sensory block level after anesthesia in the long-term group[T9(T4), T10) vs. T6(T4, T7)] and the grade of motor block [1(0,1)gradle class vs. 2(1,3) gradle class] were lower than those in short-term group. Compared with the short-term group, the long-term group had significantly higher complaints of discomfort during muscle separation after skin incision(24.0% vs. 11.5%) and abdominal exploration after uterine suture(84.0% vs. 61.5%), the differences were statistically significant(P <0.05). Conclusion For the parturients who receive epidural labor analgesia in the delivery room, the longer the duration of labor analgesia, it will not only reduce the effect of epidural anesthesia, but also increase the risk of anesthesia failure and the probability of re-puncture during the subsequent cesarean section. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to administer adequate local anesthetic in programmed intermittent epidural bolus (PIEB) to avoid breakthrough pain and decrease the use of manual and PCEA boluses. We, therefore, conducted this study to determine the effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects (EI90), without the use of patient-controlled epidural analgesia (PCEA). Methods: A total of 80 subjects were included in the final statistical analysis from 23 August 2022 to 22 November 2022. The subjects were randomly assigned to one of four different PIEB time intervals: 40, 50, 60, and 70 min (groups 40, 50, 60, and 70), respectively. The primary outcome was the effective epidural labor analgesia, defined as no use of PCEA bolus or a manual bolus until the end of the first stage of labor or within 6 hours after loading dose administration. The PIEB EI90 (95% CI) between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL was estimated using probit regression. Results: The effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects without the use of PCEA was 45.4 (35.5–50.5) minutes using probit regression. No statistical differences were found in the proportion of subjects with Bromage score > 0, hypotension, pruritus, nausea, and vomiting between groups. However, the highest sensory block (pinprick) in the 40-min group was significantly higher than that in the other groups. Conclusion: The estimated value for EI90 for PIEB between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL using probit regression was 45.4 (35.5–50.5) minutes. Furthermore, future studies are warranted to be established to determine the optimal parameters for different regimens in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background Nerve injury in epidural labor analgesia can occur with various potential causes. We report a rare case of left common peroneal nerve palsy after delivery caused by a prolonged period of sitting cross-legged during epidural labor. Case report Epidural labor analgesia in a 28-year-old primipara started at 39 weeks of gestation. She sat cross-legged to prompt delivery for approximately 4 h with a break of a few minutes every hour. She had numbness in her left lower limb and difficulty in dorsiflexion of the ankle joint that did not improve until 3 h after delivery. We made a diagnosis of left common peroneal nerve palsy. Most of the symptoms had improved at 2 months postpartum. Conclusion Epidural labor analgesia prevented recognition of prolonged peroneal head compression caused by sitting cross-legged. When this position is used to facilitate delivery, it should be released frequently owing to the possibility of a neurologic deficit.

Xinyue Hu,1– 3 Beibei Wang,1– 3 Jing Chen,1– 3 Dong Han,1– 3 Jing Wu1– 3 1Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 2Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 3Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of ChinaCorrespondence: Jing Wu, Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China, Tel +86-27-85351618, Email drjingwu@hust.edu.cnPurpose: Many studies have focused on the association between Autism spectrum disorder (ASD) and epidural labor analgesia (ELA), which is the most effective way to manage labor pain. The purpose of this meta-analysis was to summarize the current state of the association between ELA and ASD.Methods: A search of the literature yielded 201 relevant studies, of which 7 cohort studies met our inclusion criteria. Two independent reviewers screened the inclusion results, extracted data, and assessed the risk of bias and quality of evidence.Results: Compared to parturient who did not receive ELA, parturient who received ELA had a slightly increased risk of ASD (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 1.06– 1.17; I2, 69%; P < 0.001; seven studies). After excluding one literature (aHR, 1.09; 95% CI, 1.06– 1.12; I2, 4%; P < 0.001; six studies). The sensitivity analyses had consistent outcomes with the main analyses involving siblings (aHR 1.11; 95% CI 1.03– 1.19), cesarean section and instrumental deliveries (aHR 1.07; 95% CI 1.03– 1.10), non-overlapping populations (aHR 1.09; 95% CI 1.05– 1.12), full-term birth populations (aHR 1.10; 95% CI 1.06– 1.14), and studies assessed to have moderate risk of bias (aHR 1.09; 95% CI 1.02– 1.16).Conclusion: This meta-analysis revealed a modest positive association between ELA and ASD, acknowledging a slight potential risk. However, it is important to note that this risk cannot be completely dismissed due to the possibility of bias and this association is based on low-quality evidence. Future studies are required to assess and mitigate different confounding biases and investigate the time-dose-response relationship.Keywords: Autism spectrum disorder, epidural analgesia, epidural labor analgesia, ELA, neuraxial labor analgesia, pregnancy, meta-analysis

Abstract Background Breastfeeding is essential for infants and mothers. Epidural labor analgesia is used frequently to alleviate pain during vaginal delivery. Studies have found that epidural labor analgesia potentially have negative effects on postpartum breastfeeding. However, the efficacy of epidural labor analgesia on early breastfeeding after vaginal delivery is unclear. Therefore, a retrospective analysis was performed to illuminate the efficacy of epidural labor analgesia on postpartum breast feeding. Methods A total of 392 women who received vaginal delivery in the Second People’s Hospital of Foshan from July 2022 to June 2023 were selected for this study, and all women received epidural labor analgesia and were divided into three groups according to the efficacy of labor analgesia. There were three groups: parturients with VAS scores 7 were divided into Group P (n = 73). The labor process, lactation initiation time, and incidence of delayed onset of lactation were analyzed. The lactation volume and time and LATCH score at 24, 48 and 72 h after vaginal delivery were also analyzed. Results There was no significant difference in labor process times among the three groups (P > 0.05). The cases of prolactin use in Group M were less than those in Group E and Group P, with a significant difference (all P 0.05). The lactation initiation time in Group M was significantly shorter than those in Group E and Group P (all P>0.05). There was no significant difference in lactation initiation time after vaginal delivery between Group E and Group P (P>0.05). The incidence of delayed onset of lactation in Group M was significantly lower those that in Group E and Group P (all P 0.05). The lactation volumes at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P 0.05). The lactation times at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P 0.05). There was no significant difference in LATCH scores at 24, 48 and 72 h after vaginal delivery among the three groups (all P > 0.05). Conclusions Compared with labor analgesia with excellent and poor analgesia efficacy, labor analgesia with moderate analgesia efficacy has fewer cases of prolactin use, more lactation volume and time, a shorter lactation initiation time, a lower incidence of delayed onset of lactation and no effect on the LATCH score of breastfeeding.

Background: Epidural-related maternal fever (ERMF) is a common phenomenon that appears to be unique to laboring women and presents diagnostic and therapeutic dilemmas for anesthesiologists. It is crucial to identify and predict the occurrence of ERMF at an early stage to improve the outcomes for mothers and infants. This study evaluated the degree of sympathetic blockade induced by epidural labor analgesia (ELA) by quantifying blood flow spectral parameters using Pulsed-wave Doppler (PWD). The aim was to determine the predictive value of these parameters for the onset of ERMF. Methods: A total of 103 women who had vaginal deliveries with ELA were recruited into the study. PWD ultrasound was used to measure peak systolic velocity (PSV, cm/s) and end-diastolic velocity (EDV, cm/s) in the anterior and posterior tibial arteries. Measurements were taken 1 minute before induction of analgesia and at 5-minute intervals for the subsequent 30 minutes. The change of PSV (ΔPSV) and EDV (ΔEDV) at 30 minutes relative to baseline after induction of analgesia was calculated. Participants were categorized into two groups based on their body temperature during labor and delivery: febrile and afebrile. Generalized estimating equations were used to assess differences both between and within groups across multiple time points. The correlation between two variables was analyzed using Spearman's rank correlation coefficient. Receiver operating characteristic (ROC) curves were plotted to ascertain the cut-off values of lower extremity arterial ultrasound flow spectral parameters for predicting ERMF. Results: Of the 103 study participants, 73 were ultimately included for analysis. Thirteen participants (17.8%) in the study developed ERMF. PSV was significantly higher in the febrile group than the non-febrile group at 10 min after ELA (p < 0.05). In contrast, EDV showed a significant difference between the two groups at 15 min after ELA (p < 0.01). Based on linear correlation analysis, there was a positive correlation between PSV and EDV at 30 minutes after analgesia induction and the peak labor temperature (p < 0.05). ROC curve analysis identified a cut-off value of 43.35 and an area under the curve (AUC) of 0.701 for ΔPSV in the anterior tibial artery region (95% confidence interval (CI) 0.525 to 0.878, p = 0.025) and a cut-off value of 29.94 and an AUC of 0.733 for ΔEDV (95% CI 0.590 to 0.877, p = 0.001). The cut-off value for ΔPSV in the region of the posterior tibial artery was 39.96 with an AUC of 0.687 (95% CI 0.514 to 0.860, p = 0.034), and the cut-off value for ΔEDV was 33.10 with an AUC of 0.713 (95% CI 0.558 to 0.869, p = 0.007). Conclusions: Regional blood flow spectral parameters after epidural analgesia induction can predict the occurrence of ERMF by indirectly reflecting the degree of sympathetic activity inhibition. Specifically, the amount of change in peak systolic velocity and end-diastolic velocity relative to baseline parameters 30 min after ELA induction was the most predictive. Clinical Trial Registration: The study has been registered in the Chinese Clinical Trial Registry https://www.chictr.org.cn/ (reference number: ChiCTR2400080507, 31/01/2024).

Background: Nerve injury in epidural labor analgesia can occur with various potential causes. We report a rare case of left common peroneal nerve palsy after delivery caused by a prolonged period of sitting cross-legged during epidural labor. Case report: Epidural labor analgesia in a 28-year-old primipara started at 39 weeks of gestation. She sat cross-legged to prompt delivery for approximately 4 h with a break of a few minutes every hour. She had numbness in her left lower limb and difficulty in dorsiflexion of the ankle joint that did not improve until 3 h after delivery. We made a diagnosis of left common peroneal nerve palsy. Most of the symptoms had improved at 2 months postpartum. Conclusion: Epidural labor analgesia prevented recognition of prolonged peroneal head compression caused by sitting cross-legged. When this position is used to facilitate delivery, it should be released frequently owing to the possibility of a neurologic deficit. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is essential for infants and mothers. Epidural labor analgesia is used frequently to alleviate pain during vaginal delivery. Studies have found that epidural labor analgesia potentially have negative effects on postpartum breastfeeding. However, the efficacy of epidural labor analgesia on early breastfeeding after vaginal delivery is unclear. Therefore, a retrospective analysis was performed to illuminate the efficacy of epidural labor analgesia on postpartum breast feeding. Methods: A total of 392 women who received vaginal delivery in the Second People's Hospital of Foshan from July 2022 to June 2023 were selected for this study, and all women received epidural labor analgesia and were divided into three groups according to the efficacy of labor analgesia. There were three groups: parturients with VAS scores < 3 were divided into Group E (n = 192), parturients with VAS scores 4–6 were divided into Group M (n = 127), and parturients with VAS scores > 7 were divided into Group P (n = 73). The labor process, lactation initiation time, and incidence of delayed onset of lactation were analyzed. The lactation volume and time and LATCH score at 24, 48 and 72 h after vaginal delivery were also analyzed. Results: There was no significant difference in labor process times among the three groups (P > 0.05). The cases of prolactin use in Group M were less than those in Group E and Group P, with a significant difference (all P < 0.05). There was no significant difference in cases of prolactin use between Group E and Group P (P > 0.05). The lactation initiation time in Group M was significantly shorter than those in Group E and Group P (all P>0.05). There was no significant difference in lactation initiation time after vaginal delivery between Group E and Group P (P>0.05). The incidence of delayed onset of lactation in Group M was significantly lower those that in Group E and Group P (all P < 0.05). There was no statistically significant difference in the incidence of delayed onset of lactation between Group E and Group P (P > 0.05). The lactation volumes at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation volume at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). The lactation times at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation times at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). There was no significant difference in LATCH scores at 24, 48 and 72 h after vaginal delivery among the three groups (all P > 0.05). Conclusions: Compared with labor analgesia with excellent and poor analgesia efficacy, labor analgesia with moderate analgesia efficacy has fewer cases of prolactin use, more lactation volume and time, a shorter lactation initiation time, a lower incidence of delayed onset of lactation and no effect on the LATCH score of breastfeeding. [ABSTRACT FROM AUTHOR]

Background:The aim of our study was to administer adequate local anesthetic in programmed intermittent epidural bolus (PIEB) to avoid breakthrough pain and decrease the use of manual and PCEA boluses. We, therefore, conducted this study to determine the effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects (EI90), without the use of patient-controlled epidural analgesia (PCEA).Methods:A total of 80 subjects were included in the final statistical analysis from 23 August 2022 to 22 November 2022. The subjects were randomly assigned to one of four different PIEB time intervals: 40, 50, 60, and 70 min (groups 40, 50, 60, and 70), respectively. The primary outcome was the effective epidural labor analgesia, defined as no use of PCEA bolus or a manual bolus until the end of the first stage of labor or within 6 hours after loading dose administration. The PIEB EI90 (95% CI) between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL was estimated using probit regression.Results:The effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects without the use of PCEA was 45.4 (35.5–50.5) minutes using probit regression. No statistical differences were found in the proportion of subjects with Bromage score > 0, hypotension, pruritus, nausea, and vomiting between groups. However, the highest sensory block (pinprick) in the 40-min group was significantly higher than that in the other groups.Conclusion:The estimated value for EI90 for PIEB between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL using probit regression was 45.4 (35.5–50.5) minutes. Furthermore, future studies are warranted to be established to determine the optimal parameters for different regimens in clinical practice.

IntroductionThis study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA).MethodsThis study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis.ResultsOf the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p

BACKGROUND: Acupoint buried beans on the auricle is a feasible method to prevent and treat postpartum urinary retention. OBJECTIVE: This study investigated the effect of auricular acupoint buried beans on postpartum urination and maternal and fetal outcomes following epidural analgesia for labor. METHODS: Two hundred forty primiparas underwent vaginal trial labor analgesia from May 2020 to January 2021 and were randomly placed into the intervention and control groups. Both groups received epidural labor analgesia. Maternal urination during labor, 2 h postpartum, and the time for first postpartum urination were recorded as primary outcomes, with maternal and infant outcomes documented as secondary results. Statistical analysis was performed using the independent sample t -test, non-parametric rank-sum, or chi-square test using the SPSS Statistics 25.0 software. RESULTS: Two hundred eight study participants were subsequently included in the results, i.e., 105 patients in the intervention group and 103 in the control group. The intervention group comprised a significantly lower number of patients with excessive residual urine volume at cervical dilatation of 5–6 cm (P < 0.05). The total postpartum score of the intervention group was lower than in the control group (P < 0.01), and the time to first urination was shorter compared with the control group (P < 0.05). In the intervention group, the time of labor analgesia, the duration of the first stage of labor, and the total labor time were shorter compared with the control group (P < 0.01). CONCLUSION: Auricular acupoint embedded beans can improve the urination status at cervical dilatation of 5–6 cm and 2 h postpartum, as well as significantly shorten the duration of labor. [ABSTRACT FROM AUTHOR]

Weijia Du1 &ast;, Lulong Bo2 &ast;, Zhendong Xu,1 Zhiqiang Liu1 1Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhiqiang Liu; Zhendong Xu, Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China, Tel +86 13816877756 ; +86 13817029904, Email drliuzhiqiang@163.com; btxzd123@126.comAbstract: Pregnancy and childbirth are major life events for women and their families, characterized by physical, psychological, and emotional changes that can trigger anxiety, depression, and mental disorders in susceptible individuals. Acute labor pain is an independent risk factor for persistent pain in the postpartum period and is associated with depressive disorders. Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in pain management during labor. Although the relationships between labor pain, labor epidural analgesia, and postpartum depression have been studied by many investigators, the results of these studies are conflicting. Some literature suggest that labor epidural analgesia is associated with a reduction in the incidence of postpartum depression; however, other studies have failed to demonstrate this association. Unmet analgesic needs expectations, unmet birth expectations, and/or the quality of social support during labor may contribute to postpartum depression. The limitations of the published studies included differential misclassification of study variables and residual confounding, variations in the diagnosis of depression, and incomplete history data. Thus, future studies should include information on sociodemographic and patient-level variables and assessments of pain during labor or in the postpartum period. Better management of labor pain should be provided to prevent long-term morbidity and improve maternal and neonatal outcomes. Anesthesiologists could collaboratively work with obstetricians and perinatal psychiatrists to ensure that hospitals prioritize screening and treatment for postpartum depression.Keywords: epidural labor analgesia, labor pain, neuraxial analgesia, postpartum depressive disorder, pain management in labor

Objective: To investigate the effect of SLK triple therapy combined with epidural labor analgesia on pelvic floor function and perinatal outcome of primipara. Methods: 200 pregnant women who delivered singleton in Jiangyin People’s Hospital and its group hospitals from January 2022 to December 2022 were selected and randomly divided into control group, SLK triple therapy group,epidural delivery analgesia group and combined group according to random number table, with 50 cases in each group. The control group received routine training, the SLK triple therapy group received Sopfrology delivery training, Lamaze breath training and Kegel training,the epidural delivery analgesia group received patient controlled epidural analgesia, and the combined group received epidural delivery analgesia on the basis of SLK triple therapy. The pelvic floor function indexes were detected by ultrasonic diagnostic instrument(2) The pelvic floor electrophysiological indexes were detected by neuromuscular stimulation biofeedback therapeutic instrument, and the prenatal fever rate, midwifery rate, postpartum hemorrhage rate, cesarean section rate, labor process and Apgar score were recorded and compared in each group. Results: Compared with the control group, the pelvic floor ultrasonic examination △ y α, β, γ There was no significant difference among the parameters(P＞0.05); Pelvic floor ultrasonic examination △ y α, β, γ All the parameters were significantly lower than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The muscle strength of class Ⅰand class Ⅱ muscle fibers and fatigue of class Ⅰ and class Ⅱ muscle fibers in SLK group and combination group were significantly better than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The postpartum hemorrhage rate and cesarean section rate in SLK group, epidural analgesia group and combination group were significantly lower than those in the control group(P＜0.05), the first and second stages of labor in epidural analgesia group were significantly higher than those in the control group(P＜0.05), the first and second stages of labor in SLK group were significantly lower than those in the control group, and the first and second stages of labor in combination group were significantly lower than those in epidural analgesia group, Apgar score of SLK group and combined group was significantly higher than that of control group. Conclusion: SLK triple therapy combined with epidural labor analgesia can effectively improve the pelvic floor function and perinatal outcome of primipara, and make up for the shortage of epidural labor analgesia alone, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Objectives: Traditional epidural test dose is somewhat unsuited in obstetrics because of potential risk of severe adverse effects when it is accidentally injected into the subarachnoid space. Some hospitals use a proportion of the total dose of epidural labor analgesia as a test dose. The aim of our study was to assess the effectiveness and safety of ropivacaine 5 mg with sufentanil 2.5 μg to detect intrathecal injection. Methods: This prospective randomized study enrolled parturients who had the demand for epidural labor analgesia and randomly divided them into two groups. Then, 5 mL of 0.1% ropivacaine with sufentanil 2.5 μg was injected into the epidural space or the subarachnoid space in the epidural (EP) group and the intrathecal (IT) group, respectively. The ability to detect intrathecal injection and side effects were assessed to work out the effectiveness and safety. Results: For spinal injection, the sensitivity and the specificity of the symptoms of either warmth or numbness or both assessed at 3 min were both 100%, and the observed negative predictive value (NPV) and positive predictive value (PPV) were 100%. All parturients in the IT group and 2.33% of parturients in the EP group had sensory blockade to cold or pinprick (p < 0.0001). A total of 77.55% (38 of 49) of parturients in the IT group were found to have a motor block. A 10 min assessment showed the median cephalad cold and pin levels were T8 and T10, respectively, and the median Bromage score was 4 in the IT group. Incidences of adverse effects in both groups were low. Conclusions: Ropivacaine 5 mg with sufentanil 2.5 μg is effective and safe to detect intrathecal injection as an epidural test dose in obstetric patients. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the benefits of dexmedetomidine in epidural labor analgesia compared with lipophilic opioids. The databases of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and SinoMed were searched from inception to Mar. 25, 2021 for randomized controlled trials (RCT) that assessed dexmedetomidine versus lipophilic opioids as adjuvants to local anesthetics in epidural labor analgesia. Meta-analyses were conducted with RevMan 5.3, and a random-effects model was adopted. A total of 11 RCTs involving 1099 parturients were enrolled. The results showed that, compared with the control group, dexmedetomidine significantly reduced Visual Analogue Scale (VAS) scores both at 30 minutes after induction [weighted mean difference (WMD) = -0.40, 95% CI: -0.61 to -0.20] and on delivery (WMD = -0.83, 95% CI: -1.15 to -0.50), reduced analgesic consumption (WMD = -6.29 mL, 95% CI: -10.49 to -2.10), shortened the duration of the first (WMD = -9.58 minutes, 95% CI: -18.12 to -1.04) and second (WMD = -1.66 minutes, 95%CI: -3.20 to -0.12) stage of labor, increased maternal bradycardia [risk ratio (RR) = 2.44, 95% CI: 1.31 to 4.53] and motor blockade (RR = 5.30, 95% CI: 2.21 to 12.73), reduced nausea/vomiting (RR = 0.34, 95% CI: 0.20 to 0.57), pruritis (RR= 0.19, 95%CI: 0.06 to 0.58) and shivering (RR = 0.37, 95% CI: 0.18 to 0.77). There was no significant difference between groups in the rate of instrumental delivery (p = 0.68), and cesarean delivery (p = 0.40), Apgar scores at 1 minute (p = 0.24), at 5 minutes (p = 0.36), and the umbilical arterial PH (p = 0.16). In summary, compared to lipophilic opioids, dexmedetomidine for epidural labor analgesia reduced analgesic agent consumption and resulted in fewer maternal complications. [ABSTRACT FROM AUTHOR]

Abstract Background Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. Methods This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. Results Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p

BackgroundThe occurrence of gestational diabetes mellitus (GDM) is caused by a variety of factors and associated with increased risks of several adverse outcomes for both mothers and infants. However, the effects of epidural labor analgesia in parturients with GDM on maternal and infant outcomes have not been characterized.MethodsAccording to parturients' choice, they were divided into the epidural group (n = 133) and no epidural (control) group (n = 135). Data for relative variables in the perinatal period were collected, and the potential associations of epidural labor analgesia with infant outcomes were analyzed by univariate analysis and multivariate logistic regression analyses.ResultsThe rate of neonatal admission to the neonatal intensive care unit (NICU) for hypoglycemia was higher in the epidural group (7.52%) than in the control group (1.48%; P

Background: Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. Methods: This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. Results: Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. Conclusions: For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined. Trial registration: www.chictr.org.cn; identifier: ChiCTR-IOR-17011994; registered on 14 July 2017. [ABSTRACT FROM AUTHOR]

Abstract Background Whether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes. Methods This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid. Results There were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group. Conclusions 0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine. Trial registration Clinical Research Information Service with registration number ChiCTR2100045162 . Registered 7 April 2021.

To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice. Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes. Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8–10 points. Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. Objective: Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 μg/ml for epidural labor analgesia. Materials and Methods: A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 μg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 μg/ml, respectively, as an initial bolus dose and intermittent top-up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded. Results: Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes. Conclusion: We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl.

BackgroundFor pregnant women transferred to emergency cesarean section after receiving epidural labor analgesia, there is still a debate over the effective and safe means of rapidly delivering surgical anesthesia. Alkalized lidocaine is often adopted for fast onset time; however, crystallization of the anesthetic may cause severe neurologic symptoms.Case PresentationWe report a case of a pregnant woman who underwent emergency cesarean section with satisfied analgesia but experienced severe weakness and paranaesthesia in the lower limb. After excluding lumbar disc herniation, obstetric nerve injury, and anesthesia technique causes by symptoms signs and magnetic resonance imaging, drug-related injury became the most likely cause. Our in vitro testing confirmed the obvious precipitation of additional anesthetic-concentrated ropivacaine (0.5–1%) with pretreated alkalized lidocaine. With trophic neurotherapy, the parturient attained prompt relief of weakness by day four, but delayed recovery of numbness, which lasted for 4 weeks.ConclusionTo date, this is the first case reporting neurologic complication possibly due to drug crystallization in cesarean section. Our study confirmed the rapid onset of alkalized lidocaine and its safety to pretreated routine labor dose of ropivacaine (0.09%). However, additional anesthetic-concentrated ropivacaine (0.5–1%) to maintain the anesthesia and analgesia level is not suggested.

Background: Labor pain is an inevitable experience for parturients with choice for labor analgesia depending on awareness, parturients' education, availability, cost and adverse effects of the analgesic materials. Methods: All pregnant women attending booking clinics in the obstetric units of our hospital were recruited into an open-label randomized control trial for a period of 3 months into either intervention or control group. The pregnant women in the intervention group were shown a video demonstration on epidural labor analgesia in addition to distribution of epidural information leaflets with verbal explanation on pain management in labour. The control group had the same exposure except the video demonstration. An interviewer semi-structured questionnaire was used to collect information on biodata, knowledge of pain management in labor, previous labor pain experience, willingness to receive epidural labor analgesia in the current pregnancy and factors associated with willingness to receive epidural labor analgesia. Data were analyzed using descriptive and inferential statistics with P < 0.05 accepted as statistically significant. Results: Out of the 199 expectant mothers that participated in the study, 95 (47.7%) were in the intervention group and 104 (52.3%) in the control group with 18 (18.9%) and 5 (4.8%) patients had prior knowledge of epidural labor analgesia respectively. A higher proportion of 41 (43.2%) of participants in the intervention group were willing to receive epidural analgesia in the current pregnancy, when compared with 13 (12.5%) in the control group (P = 0.001). Conclusion: Addition of video demonstration to epidural leaflet information with verbal explanation in the intervention group increased the willingness of pregnant women to request for epidural pain relief in the current pregnancy compared to the control group.

Aim: The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. Objective: Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 µg/ml for epidural labor analgesia. Materials and Methods: A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 µg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 µg/ml, respectively, as an initial bolus dose and intermittent top‑up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded. Results: Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes. Conclusion: We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top‑ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to administer adequate local anesthetic in programmed intermittent epidural bolus (PIEB) to avoid breakthrough pain and decrease the use of manual and PCEA boluses. We, therefore, conducted this study to determine the effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects (EI 90 ), without the use of patient-controlled epidural analgesia (PCEA)., Methods: A total of 80 subjects were included in the final statistical analysis from 23 August 2022 to 22 November 2022. The subjects were randomly assigned to one of four different PIEB time intervals: 40, 50, 60, and 70 min (groups 40, 50, 60, and 70), respectively. The primary outcome was the effective epidural labor analgesia, defined as no use of PCEA bolus or a manual bolus until the end of the first stage of labor or within 6 hours after loading dose administration. The PIEB EI 90 (95% CI) between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL was estimated using probit regression., Results: The effective PIEB interval time between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL in 90% of subjects without the use of PCEA was 45.4 (35.5-50.5) minutes using probit regression. No statistical differences were found in the proportion of subjects with Bromage score > 0, hypotension, pruritus, nausea, and vomiting between groups. However, the highest sensory block (pinprick) in the 40-min group was significantly higher than that in the other groups., Conclusion: The estimated value for EI 90 for PIEB between boluses of ropivacaine 0.0625% with dexmedetomidine 0.4 μg/ml at a fixed volume of 10 mL using probit regression was 45.4 (35.5-50.5) minutes. Furthermore, future studies are warranted to be established to determine the optimal parameters for different regimens in clinical practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mei, Wang, Song, Lu and Yu.)

Worldwide, there are only few studies focusing on labor analgesia on the MLAC (minimum local analgesic concentration) or EC50 (median effective concentration) of sufentanil and ropivacaine. Therefore, we determine the MLAC or EC50 of sufentanil and ropivacaine for epidural analgesia by using an up–down sequential allocation and survey its adverse effect in a prospective blinded randomized trial. Sixty nulliparous full-term parturients who required labor analgesia were recruited and randomly divided into the sufentanil and ropivacaine groups. The formulation was 25 μg sufentanil combined with 0.1% ropivacaine (added 0.9% normal saline to 75 ml). According to the response of a previous parturient, the dosage of sufentanil was increased or decreased by 5 μg in the sufetanil group; meanwhile, we also administrated an initial concentration of 0.1% ropivacaine combined with 22.5 μg sufentanil (added 0.9% normal saline to 75 ml) in the ropivacaine group. The concentration of ropivacaine was increased or decreased by 0.01% following the response of the previous parturient. The Brownlee up–down sequential allocation was used to estimate the MLAC of epidural ropivacaine and its 95% confidence intervals in labor analgesia. There were no significant changes for the two groups, including for age, height weight, active stage, second stage of labor, and gestational weeks (P = 0.769, 0.900, 0.603, 0.441, 0.577, and 0.695, respectively). The VAS scores of the parturient decreased to varying degrees (P < 0.0001) after labor analgesia compared with VAS before labor analgesia, and the most effective analgesia was reached in 60 min. The EC50 dose of epidural ropivacaine combined with 0.3 μg/mL sufentanil was 0.09687%, and the 95% CI was 0.08944%~0.1043%. Five parturients had PONV, and the incidence rate was 16.7%; one parturient had pruritus, so the incidence rate was 3.3%. The EC50 dose of epidural sulfetanil combined with 0.1% ropivacaine was 18.76 μg with a 95% confidence interval of 13.5–24.48 μg. There were no significant differences in the active stage, second stage of labor, and maternal and fetal hemodynamic data between the two groups. Notably, the Apgar scores for 1 min and 5 min were 10 scores for almost all of these patients. There were no significant differences between the two groups for maternal and fetal side effects, which had very low incidence rates. The MLAC of epidural sufentanil or ropivacaine could provide satisfactory and safe analgesia for parturients while having a low incidence rate of side effects. [ABSTRACT FROM AUTHOR]

Background: Labor pain is an inevitable experience for parturients with choice for labor analgesia depending on awareness, parturients' education, availability, cost and adverse effects of the analgesic materials. Methods: All pregnant women attending booking clinics in the obstetric units of our hospital were recruited into an open-label randomized control trial for a period of 3 months into either intervention or control group. The pregnant women in the intervention group were shown a video demonstration on epidural labor analgesia in addition to distribution of epidural information leaflets with verbal explanation on pain management in labour. The control group had the same exposure except the video demonstration. An interviewer semi-structured questionnaire was used to collect information on biodata, knowledge of pain management in labor, previous labor pain experience, willingness to receive epidural labor analgesia in the current pregnancy and factors associated with willingness to receive epidural labor analgesia. Data were analyzed using descriptive and inferential statistics with P < 0.05 accepted as statistically significant. Results: Out of the 199 expectant mothers that participated in the study, 95 (47.7%) were in the intervention group and 104 (52.3%) in the control group with 18 (18.9%) and 5 (4.8%) patients had prior knowledge of epidural labor analgesia respectively. A higher proportion of 41 (43.2%) of participants in the intervention group were willing to receive epidural analgesia in the current pregnancy, when compared with 13 (12.5%) in the control group (P = 0.001). Conclusion: Addition of video demonstration to epidural leaflet information with verbal explanation in the intervention group increased the willingness of pregnant women to request for epidural pain relief in the current pregnancy compared to the control group. [ABSTRACT FROM AUTHOR]

• Spinal cord compression is a rare complication of an inadvertent dural puncture (ADP) • Puncture can cause a substantial cerebrospinal fluid (CSF) leak to the epidural space. • CSF effusion compressing the spinal cord can cause 'electric shock'-like paresthesia. • Neuro-imaging should be considered for a symptomatic patient after a potential ADP. • Repeated neuro-imaging should be performed if symptoms persist to verify etiology. We report a rare complication of an inadvertent dural puncture in an obstetric patient. A 24-year-old healthy primipara had a difficult neuraxial labor analgesia insertion. Subsequently she developed severe back pain and started having 'electric shock'-like sensations radiating from the spine to the lower extremities, raising a suspicion of a vertebral canal hematoma. Topping up the epidural for emergency cesarean section was unsuccessful and the surgery was done under general anesthesia. Subsequent emergency magnetic resonance imaging (MRI) of the spine showed no signs of bleeding but her symptoms persisted, and a repeat MRI of the spine ultimately revealed substantial epidural fluid collection extending from the cervical level to the lower thoracic spine, with signs of intracranial hypotension in the MRI of the brain. The dorsal dura and the spinal cord were displaced anteriorly and there was a slight compression of the spinal cord. Repeated neuro-imaging led to the diagnosis of a previously unrecognized inadvertent dural puncture and extensive cerebrospinal fluid spread within the epidural space, causing a sensory phenomenon in the spine and lower extremities known as Lhermitte's sign. An epidural blood patch relieved the symptoms and restored cerebrospinal fluid surrounding the spinal cord, demonstrated at follow-up MRI. In conclusion, a repeated MRI of the spine and brain should be performed if the patient has persistent symptoms in the back or extremities, in order to detect a possible undiagnosed dural puncture complicated by the potentially serious consequences of extradural fluid leakage. [ABSTRACT FROM AUTHOR]

BackgroundThe conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS.MethodsBoth groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups.ResultsThe failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups.ConclusionsSA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.

Introduction: This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA)., Methods: This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis., Results: Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated ( p  < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively., Conclusion: The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers., Clinical Trial Registration: This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Wu, Zhou, Du, Xu and Liu.)

Objective To evaluate the treatment effects of epidural labor analgesia on syndecan-1 in patients with preeclampsia. Methods During Jan., 2016 and Dec., 2017, 150 unipara females with preeclampsia and gestational age>37 weeks were enrolled in the prospective cohort study.They were devided into intervention and control group (n=75 in each group) with and without epidural labor analgesia, based on whether epidural labor analgesia applications were made by the patients at the first examination of cervical dilation of 2 cm. The primary outcomes were mean change and change rate of syndecan-1 from baseline to 2 h post-treatment, and the secondary outcomes were visual analogue scale (VAS), IL-6 level and mean arterial pressure (MAP). Results Absolute change of syndecan-1 from baseline to 2 h post-baseline was (-11.49±82.80) ng/mL in the intervention group and (45.09±55.14) ng/mL in the control group, respectively.There was a significant difference in mean change of syndecan-1 between the two groups (P<0.001). Similarly, the intervention group exhibited a greater reduction in change rate of syndecan-1 compared with the control group (P<0.001). Moreover, the[CS] [CSD%15, 0, 10, 0] [FK(WB8001ZQ2*2] [WT10.BZ] intervention group had greater reduction in VAS and MAP compared with the control group (P<0.001 for both). There was no significant difference in IL-6 level between the two groups. Conclusions Epidural labor analgesia was associated with greater reduction in syndecan-1, VAS and MAP compared with the control condition.In contrast, administration of epidural analgesia did not significantly change IL-6 level. [ABSTRACT FROM AUTHOR]

Aim: Pregnancy with myasthenia gravis (MG) is known to be associated with an increased cesarean section rate, presumably due to maternal fatigue during labor. Although epidural labor analgesia (ELA) appears to be a good option for circumventing maternal fatigue, a protocol for managing MG deliveries has not been established. This study, based on a review of our case series, aimed to evaluate the validity of our management protocol for maternal MG, in which ELA is used depending on MG severity. Methods: Parturients with systemic muscle weakness or worsening symptoms were classified as Category A (A), and those without symptoms were classified as Category B (B). In A, ELA was given at the onset of labor. Immediate vacuum delivery was done once the fetal head descended to station +2. For B, spontaneous vaginal delivery was chosen. The duration, blood loss, fetal weight, Apgar score and MG symptoms on post‐partum day (PPD) 1, 14 and 30 were recorded. Results: Six patients were enrolled. Four were classified in A, and two were classified in B. No adverse events occurred during labor. Transvaginal delivery was successfully achieved in all the patients. Symptoms of MG were well‐controlled. MG symptoms were stable on PPD 1 in all the patients although two patients complained of worsening symptoms after PPD 14. Conclusion: Women with MG can safely undergo spontaneous or operative vaginal delivery. ELA is a good option for circumventing the effects of maternal fatigue on delivery. Our protocol may lower the cesarean section rate in maternal MG. [ABSTRACT FROM AUTHOR]

Objective: We designed this study to test whether dexmedetomidine 1 μg/kg can be an alternative to epinephrine 5 μg/ml (1/200.000) as an adjuvant to lidocaine 2% for fastening the extension of labor epidural analgesia into an adequate block for emergency cesarean section (CS). Methods: Sixty patients having epidural analgesia for normal delivery who required emergency CS were assigned to either lidocaine–epinephrine (LE) group (n = 30) received 19 ml of lidocaine 2% and 1 ml containing 5 μg epinephrine or lidocaine–dexmedetomidine (LD) group (n = 30) received 19 ml of lidocaine 2% and 1 ml containing 1 μg/kg dexmedetomidine. If the patient feels any discomfort (VAS >3) during surgery, intravenous fentanyl 25–50 μg was given. Sedation level was assessed using five points numerical scale. Results: Both groups were comparable regarding the onset time and time to maximum block height, p value >0.05. The number of patients required intraoperative fentanyl was higher in LE group compared to LD group, p value

Objective: The aim of this study was to compare the impacts of 0.15% ropivacaine alone and 0.15% ropivacaine combined with sufentanil on epidural labor analgesia., Methods: A total of 297 eligible primiparae were randomly divided into group A (n=149, 0.15% ropivacaine + sufentanil) and group B (n=148, 0.15% ropivacaine). Visual analogue scale (VAS) scores prior to analgesia and 20 min following epidural medication, the maximum VAS score during labor, dosage of analgesic drugs, modified Bromage score, satisfaction degree, labor duration, delivery mode, 1-min and 5-min Apgar scores of newborns, adverse reactions during analgesia, and fever during labor were recorded., Results: Group A and B had similar VAS scores 20 min following epidural medication and maximum score during labor (P>0.05), which significantly fell compared with those before labor analgesia (P<0.05). The occurrence rates of nausea and vomiting were of significant difference (P<0.05)., Conclusion: 0.15% ropivacaine alone achieves a comparable epidural labor analgesia effect to that of 0.15% ropivacaine + 0.05 µg/mL sufentanil on primiparae., Competing Interests: The authors declare no conflict of interest., (© 2023 Zhong H et al.)

Background and Aims: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. Settings and Design: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing. Methodology: Sixty parturients requesting for labor analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R (n = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed. Statistical Analysis: Data were analyzed with odds variance, unpaired t-test, and Chi-square tests. P < 0.05 was considered statistically significant. Results: In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups. Conclusions: In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl. [ABSTRACT FROM AUTHOR]

Background: Minimum effective concentration of local anesthetics for providing optimal labor epidural analgesia and the strategies aiming to reduce their consumption are continuously being searched. Objectives: The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine both mixed with fentanyl 2 mcg/ml for epidural labor analgesia. Materials and Methods: A total of 80 parturients in active labor were randomly assigned to two groups of 40 each, to receive an epidural injection of 15 ml ropivacaine 0.125% with fentanyl (2 mcg/ml) in group R1 and 15 ml of ropivacaine 0.2% with fentanyl (2 mcg/ml) in group R2 as initial bolus dose. Same dose regimen was used as subsequent top-up dose on patients demand for pain relief. The duration and quality of analgesia, motor block, top-up doses required consumption of ropivacaine and fentanyl and feto-maternal outcome in both groups were compared. Results: Effective labor analgesia with no motor blockade was observed in both groups with no failure rate. Onset of analgesia was significantly faster in group R2 (75% parturients in 0-5 min) as compared to group R1 (25% parturients in 0-5 min), P < 0.001. Duration of analgesia after initial bolus dose was also significantly longer in group R2 (132 ± 56.81 min) than in group R1 (72.25 ± 40.26 min), P < 0.001. Mean VAS scores were significantly less in group R2 than in group R1 at 5, 60, and 90 min, P < 0.01. Requirement of top-up doses was significantly less in group R2 (0.05 ± 0.22) as compared to group R1 (0.80 ± 0.65), P < 0.001. Consumption of ropivacaine was comparable in both the groups (33.75 ± 12.16 mg in group R1 and 31.50 ± 6.62 mg in group R2 P > 0.05), but consumption of fentanyl was significantly more in group R1 (54.00 ± 19.45) as compared to group R2 (31.50 ± 6.62), P < 0.001. There were no significant changes in hemodynamics, nor adverse effects related to neonatal or maternal outcomes in both groups. Conclusion: We conclude that both the concentrations of ropivacaine (0.2% and 0.125%) with fentanyl are effective in producing epidural labor analgesia. However, 0.2% concentration was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids.

The management of a patient presenting with unsatisfactory labor epidural analgesia poses a severe challenge for the anesthetist wanting to provide safe anesthetic care for a cesarean delivery. Early recognition of unsatisfactory labor analgesia allows for replacement of the epidural catheter. The decision to convert labor epidural analgesia to anesthesia for cesarean delivery is based on the urgency of the cesarean delivery, airway examination, and the existence of a residual sensory and motor block. We suggest an algorithm which is implemented in our department, based on the urgency of the cesarean delivery.

Objective We designed this study to test whether dexmedetomidine 1 μg/kg can be an alternative to epinephrine 5 μg/ml (1/200.000) as an adjuvant to lidocaine 2% for fastening the extension of labor epidural analgesia into an adequate block for emergency cesarean section (CS). Methods Sixty patients having epidural analgesia for normal delivery who required emergency CS were assigned to either lidocaine–epinephrine (LE) group ( n = 30) received 19 ml of lidocaine 2% and 1 ml containing 5 μg epinephrine or lidocaine–dexmedetomidine (LD) group ( n = 30) received 19 ml of lidocaine 2% and 1 ml containing 1 μg/kg dexmedetomidine. If the patient feels any discomfort (VAS >3) during surgery, intravenous fentanyl 25–50 μg was given. Sedation level was assessed using five points numerical scale. Results Both groups were comparable regarding the onset time and time to maximum block height, p value >0.05. The number of patients required intraoperative fentanyl was higher in LE group compared to LD group, p value <0.05. The mean total fentanyl supplementation was more in LE group compared to LD group, p value <0.001. Overall sedation score was higher in LD group than in LE group ( p value <0.001), and more patients had bradycardia in LD group compared to LE group ( p value <0.001). The mean time to two segment regression, mean time to regression to Bromage 0 and mean time to first analgesic requirement were significantly longer in LD group compared to LE group, p value <0.001. Conclusion Epidural dexmedetomidine is comparable to epinephrine as an adjuvant to epidural lidocaine in fastening the onset of surgical anesthesia and resulted in better intraoperative analgesia and in longer duration of sensory and motor block in the settings of converting labor epidural analgesia for emergency CS. [ABSTRACT FROM AUTHOR]