Analgesia: Methods of PAIN relief that may be used with or in place of ANALGESICS.Analgesia, Epidural: The relief of pain without loss of consciousness through the introduction of an analgesic agent into the epidural space of the vertebral canal. It is differentiated from ANESTHESIA, EPIDURAL which refers to the state of insensitivity to sensation.Analgesia, Obstetrical: The elimination of PAIN, without the loss of CONSCIOUSNESS, during OBSTETRIC LABOR; OBSTETRIC DELIVERY; or the POSTPARTUM PERIOD, usually through the administration of ANALGESICS.Analgesia, Patient-Controlled: Relief of PAIN, without loss of CONSCIOUSNESS, through ANALGESIC AGENTS administered by the patients. It has been used successfully to control POSTOPERATIVE PAIN, during OBSTETRIC LABOR, after BURNS, and in TERMINAL CARE. The choice of agent, dose, and lockout interval greatly influence effectiveness. The potential for overdose can be minimized by combining small bolus doses with a mandatory interval between successive doses (lockout interval).Analgesics, Opioid: Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS.Pain, Postoperative: Pain during the period after surgery.Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle.Pain Measurement: Scales, questionnaires, tests, and other methods used to assess pain severity and duration in patients or experimental animals to aid in diagnosis, therapy, and physiological studies.Bupivacaine: A widely used local anesthetic agent.Anesthetics, Local: Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate.Acupuncture Analgesia: Analgesia produced by the insertion of ACUPUNCTURE needles at certain ACUPUNCTURE POINTS on the body. This activates small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary/hypothalamus - to produce analgesia.Fentanyl: A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078)Analgesics: Compounds capable of relieving pain without the loss of CONSCIOUSNESS.Anesthesia, Epidural: Procedure in which an anesthetic is injected into the epidural space.Meperidine: A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration.Labor Pain: Pain associated with OBSTETRIC LABOR in CHILDBIRTH. It is caused primarily by UTERINE CONTRACTION as well as pressure on the CERVIX; BLADDER; and the GASTROINTESTINAL TRACT. Labor pain mostly occurs in the ABDOMEN; the GROIN; and the BACK.Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent.Pain: An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS.Nerve Block: Interruption of NEURAL CONDUCTION in peripheral nerves or nerve trunks by the injection of a local anesthetic agent (e.g., LIDOCAINE; PHENOL; BOTULINUM TOXINS) to manage or treat pain.Injections, Spinal: Introduction of therapeutic agents into the spinal region using a needle and syringe.Labor, Obstetric: The repetitive uterine contraction during childbirth which is associated with the progressive dilation of the uterine cervix (CERVIX UTERI). Successful labor results in the expulsion of the FETUS and PLACENTA. Obstetric labor can be spontaneous or induced (LABOR, INDUCED).Anesthesia, Obstetrical: A variety of anesthetic methods such as EPIDURAL ANESTHESIA used to control the pain of childbirth.Amides: Organic compounds containing the -CO-NH2 radical. Amides are derived from acids by replacement of -OH by -NH2 or from ammonia by the replacement of H by an acyl group. (From Grant & Hackh's Chemical Dictionary, 5th ed)Anesthesia, Spinal: Procedure in which an anesthetic is injected directly into the spinal cord.Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating.Double-Blind Method: A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.Analgesics, Non-Narcotic: A subclass of analgesic agents that typically do not bind to OPIOID RECEPTORS and are not addictive. Many non-narcotic analgesics are offered as NONPRESCRIPTION DRUGS.Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors.Cesarean Section: Extraction of the FETUS by means of abdominal HYSTEROTOMY.Postoperative Nausea and Vomiting: Emesis and queasiness occurring after anesthesia.Pain Threshold: Amount of stimulation required before the sensation of pain is experienced.Interpleural Analgesia: Injection of ANALGESICS; LOCAL ANESTHETICS; or NARCOTICS into the PLEURAL CAVITY between the two pleural membranes.Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from DRUG RESISTANCE wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from MAXIMUM TOLERATED DOSE and NO-OBSERVED-ADVERSE-EFFECT LEVEL.Receptors, Opioid, mu: A class of opioid receptors recognized by its pharmacological profile. Mu opioid receptors bind, in decreasing order of affinity, endorphins, dynorphins, met-enkephalin, and leu-enkephalin. They have also been shown to be molecular receptors for morphine.Anesthesia, General: Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery.Conscious Sedation: A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway. (From: American Society of Anesthesiologists Practice Guidelines)Ketorolac: A pyrrolizine carboxylic acid derivative structurally related to INDOMETHACIN. It is an NSAID and is used principally for its analgesic activity. (From Martindale The Extra Pharmacopoeia, 31st ed)Labor Stage, First: Period from the onset of true OBSTETRIC LABOR to the complete dilatation of the CERVIX UTERI.Hydromorphone: An opioid analgesic made from MORPHINE and used mainly as an analgesic. It has a shorter duration of action than morphine.Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of PROCAINE but its duration of action is shorter than that of BUPIVACAINE or PRILOCAINE.Pain Management: A form of therapy that employs a coordinated and interdisciplinary approach for easing the suffering and improving the quality of life of those experiencing pain.Anesthesia, Caudal: Epidural anesthesia administered via the sacral canal.Clonidine: An imidazoline sympatholytic agent that stimulates ALPHA-2 ADRENERGIC RECEPTORS and central IMIDAZOLINE RECEPTORS. It is commonly used in the management of HYPERTENSION.Anesthesia and Analgesia: Medical methods of either relieving pain caused by a particular condition or removing the sensation of pain during a surgery or other medical procedure.Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (RECEPTORS, N-METHYL-D-ASPARTATE) and may interact with sigma receptors.Femoral Nerve: A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints.Receptors, Opioid: Cell membrane proteins that bind opioids and trigger intracellular changes which influence the behavior of cells. The endogenous ligands for opioid receptors in mammals include three families of peptides, the enkephalins, endorphins, and dynorphins. The receptor classes include mu, delta, and kappa receptors. Sigma receptors bind several psychoactive substances, including certain opioids, but their endogenous ligands are not known.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Pirinitramide: A diphenylpropylamine with intense narcotic analgesic activity of long duration. It is a derivative of MEPERIDINE with similar activity and usage.Hypnotics and Sedatives: Drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety.Butorphanol: A synthetic morphinan analgesic with narcotic antagonist action. It is used in the management of severe pain.Alfentanil: A short-acting opioid anesthetic and analgesic derivative of FENTANYL. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients.Nalbuphine: A narcotic used as a pain medication. It appears to be an agonist at kappa opioid receptors and an antagonist or partial agonist at mu opioid receptors.Narcotic Antagonists: Agents inhibiting the effect of narcotics on the central nervous system.Anesthetics, Combined: The use of two or more chemicals simultaneously or sequentially to induce anesthesia. The drugs need not be in the same dosage form.Anesthesia, Conduction: Injection of an anesthetic into the nerves to inhibit nerve transmission in a specific part of the body.Thoracotomy: Surgical incision into the chest wall.Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the ENKEPHALINS, the DYNORPHINS, and the ENDORPHINS. Each of these families derives from different precursors, proenkephalin, prodynorphin, and PRO-OPIOMELANOCORTIN, respectively. There are also at least three classes of OPIOID RECEPTORS, but the peptide families do not map to the receptors in a simple way.Electroacupuncture: A form of acupuncture with electrical impulses passing through the needles to stimulate NERVE TISSUE. It can be used for ANALGESIA; ANESTHESIA; REHABILITATION; and treatment for diseases.Mepivacaine: A local anesthetic that is chemically related to BUPIVACAINE but pharmacologically related to LIDOCAINE. It is indicated for infiltration, nerve block, and epidural anesthesia. Mepivacaine is effective topically only in large doses and therefore should not be used by this route. (From AMA Drug Evaluations, 1994, p168)Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief.Ketoprofen: An IBUPROFEN-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis.Adjuvants, Anesthesia: Agents that are administered in association with anesthetics to increase effectiveness, improve delivery, or decrease required dosage.Placebo Effect: An effect usually, but not necessarily, beneficial that is attributable to an expectation that the regimen will have an effect, i.e., the effect is due to the power of suggestion.Morphine Derivatives: Analogs or derivatives of morphine.Hyperalgesia: An increased sensation of pain or discomfort produced by mimimally noxious stimuli due to damage to soft tissue containing NOCICEPTORS or injury to a peripheral nerve.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Anesthesia, Local: A blocking of nerve conduction to a specific area by an injection of an anesthetic agent.Periaqueductal Gray: Central gray matter surrounding the CEREBRAL AQUEDUCT in the MESENCEPHALON. Physiologically it is probably involved in RAGE reactions, the LORDOSIS REFLEX; FEEDING responses, bladder tonus, and pain.Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream.Pentazocine: The first mixed agonist-antagonist analgesic to be marketed. It is an agonist at the kappa and sigma opioid receptors and has a weak antagonist action at the mu receptor. (From AMA Drug Evaluations Annual, 1991, p97)Postoperative Care: The period of care beginning when the patient is removed from surgery and aimed at meeting the patient's psychological and physical needs directly after surgery. (From Dictionary of Health Services Management, 2d ed)Dexmedetomidine: A imidazole derivative that is an agonist of ADRENERGIC ALPHA-2 RECEPTORS. It is closely-related to MEDETOMIDINE, which is the racemic form of this compound.Ambulatory Surgical Procedures: Surgery performed on an outpatient basis. It may be hospital-based or performed in an office or surgicenter.Hysterectomy: Excision of the uterus.Piperidines: A family of hexahydropyridines.Dose-Response Relationship, Drug: The relationship between the dose of an administered drug and the response of the organism to the drug.Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon.Pain, Intractable: Persistent pain that is refractory to some or all forms of treatment.Oxycodone: A semisynthetic derivative of CODEINE.Pain Perception: The process by which PAIN is recognized and interpreted by the brain.Injections, Epidural: The injection of drugs, most often analgesics, into the spinal canal without puncturing the dura mater.Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage.Anesthesia, Intravenous: Process of administering an anesthetic through injection directly into the bloodstream.Anesthetics, Dissociative: Intravenous anesthetics that induce a state of sedation, immobility, amnesia, and marked analgesia. Subjects may experience a strong feeling of dissociation from the environment. The condition produced is similar to NEUROLEPTANALGESIA, but is brought about by the administration of a single drug. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed)Prilocaine: A local anesthetic that is similar pharmacologically to LIDOCAINE. Currently, it is used most often for infiltration anesthesia in dentistry.Nociceptors: Peripheral AFFERENT NEURONS which are sensitive to injuries or pain, usually caused by extreme thermal exposures, mechanical forces, or other noxious stimuli. Their cell bodies reside in the DORSAL ROOT GANGLIA. Their peripheral terminals (NERVE ENDINGS) innervate target tissues and transduce noxious stimuli via axons to the CENTRAL NERVOUS SYSTEM.Delivery, Obstetric: Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions.Obstetric Labor Complications: Medical problems associated with OBSTETRIC LABOR, such as BREECH PRESENTATION; PREMATURE OBSTETRIC LABOR; HEMORRHAGE; or others. These complications can affect the well-being of the mother, the FETUS, or both.Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike PHYSOSTIGMINE, does not cross the blood-brain barrier.Nociceptive Pain: Dull or sharp aching pain caused by stimulated NOCICEPTORS due to tissue injury, inflammation or diseases. It can be divided into somatic or tissue pain and VISCERAL PAIN.Injections, Intravenous: Injections made into a vein for therapeutic or experimental purposes.Extraction, Obstetrical: Extraction of the fetus by means of obstetrical instruments.Dipyrone: A drug that has analgesic, anti-inflammatory, and antipyretic properties. It is the sodium sulfonate of AMINOPYRINE.Anti-Inflammatory Agents, Non-Steroidal: Anti-inflammatory agents that are non-steroidal in nature. In addition to anti-inflammatory actions, they have analgesic, antipyretic, and platelet-inhibitory actions.They act by blocking the synthesis of prostaglandins by inhibiting cyclooxygenase, which converts arachidonic acid to cyclic endoperoxides, precursors of prostaglandins. Inhibition of prostaglandin synthesis accounts for their analgesic, antipyretic, and platelet-inhibitory actions; other mechanisms may contribute to their anti-inflammatory effects.Spinal Cord: A cylindrical column of tissue that lies within the vertebral canal. It is composed of WHITE MATTER and GRAY MATTER.Drug Administration Schedule: Time schedule for administration of a drug in order to achieve optimum effectiveness and convenience.Subarachnoid Space: The space between the arachnoid membrane and PIA MATER, filled with CEREBROSPINAL FLUID. It contains large blood vessels that supply the BRAIN and SPINAL CORD.Narcotics: Agents that induce NARCOSIS. Narcotics include agents that cause somnolence or induced sleep (STUPOR); natural or synthetic derivatives of OPIUM or MORPHINE or any substance that has such effects. They are potent inducers of ANALGESIA and OPIOID-RELATED DISORDERS.Injections, Intra-Articular: Methods of delivering drugs into a joint space.Codeine: An opioid analgesic related to MORPHINE but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough.Nefopam: Non-narcotic analgesic chemically similar to ORPHENADRINE. Its mechanism of action is unclear. It is used for the relief of acute and chronic pain. (From Martindale, The Extra Pharmacopoeia, 30th ed, p26)Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.Infusions, Intravenous: The long-term (minutes to hours) administration of a fluid into the vein through venipuncture, either by letting the fluid flow by gravity or by pumping it.Buprenorphine: A derivative of the opioid alkaloid THEBAINE that is a more potent and longer lasting analgesic than MORPHINE. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use.Perioperative Care: Interventions to provide care prior to, during, and immediately after surgery.Heroin: A narcotic analgesic that may be habit-forming. It is a controlled substance (opium derivative) listed in the U.S. Code of Federal Regulations, Title 21 Parts 329.1, 1308.11 (1987). Sale is forbidden in the United States by Federal statute. (Merck Index, 11th ed)Apgar Score: A method, developed by Dr. Virginia Apgar, to evaluate a newborn's adjustment to extrauterine life. Five items - heart rate, respiratory effort, muscle tone, reflex irritability, and color - are evaluated 60 seconds after birth and again five minutes later on a scale from 0-2, 0 being the lowest, 2 being normal. The five numbers are added for the Apgar score. A score of 0-3 represents severe distress, 4-7 indicates moderate distress, and a score of 7-10 predicts an absence of difficulty in adjusting to extrauterine life.Preanesthetic Medication: Drugs administered before an anesthetic to decrease a patient's anxiety and control the effects of that anesthetic.Administration, Rectal: The insertion of drugs into the rectum, usually for confused or incompetent patients, like children, infants, and the very old or comatose.Rats, Sprague-Dawley: A strain of albino rat used widely for experimental purposes because of its calmness and ease of handling. It was developed by the Sprague-Dawley Animal Company.Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few - MORPHINE; CODEINE; and PAPAVERINE - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic.Anesthesia Recovery Period: The period of emergence from general anesthesia, where different elements of consciousness return at different rates.Receptors, Opioid, kappa: A class of opioid receptors recognized by its pharmacological profile. Kappa opioid receptors bind dynorphins with a higher affinity than endorphins which are themselves preferred to enkephalins.Receptors, Opioid, delta: A class of opioid receptors recognized by its pharmacological profile. Delta opioid receptors bind endorphins and enkephalins with approximately equal affinity and have less affinity for dynorphins.ThiazinesInfusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (INSULIN INFUSION SYSTEMS is also available), and other disorders.beta-Endorphin: A 31-amino acid peptide that is the C-terminal fragment of BETA-LIPOTROPIN. It acts on OPIOID RECEPTORS and is an analgesic. Its first four amino acids at the N-terminal are identical to the tetrapeptide sequence of METHIONINE ENKEPHALIN and LEUCINE ENKEPHALIN.Enkephalin, Ala(2)-MePhe(4)-Gly(5)-: An enkephalin analog that selectively binds to the MU OPIOID RECEPTOR. It is used as a model for drug permeability experiments.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Abdomen: That portion of the body that lies between the THORAX and the PELVIS.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Injections, Intramuscular: Forceful administration into a muscle of liquid medication, nutrient, or other fluid through a hollow needle piercing the muscle and any tissue covering it.Dihydromorphine: A semisynthetic analgesic used in the study of narcotic receptors.Adrenergic alpha-Agonists: Drugs that selectively bind to and activate alpha adrenergic receptors.Nociception: Sensing of noxious mechanical, thermal or chemical stimuli by NOCICEPTORS. It is the sensory component of visceral and tissue pain (NOCICEPTIVE PAIN).Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of NALOXONE. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence.Drug Combinations: Single preparations containing two or more active agents, for the purpose of their concurrent administration as a fixed dose mixture.Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla.Infusions, Parenteral: The administration of liquid medication, nutrient, or other fluid through some other route than the alimentary canal, usually over minutes or hours, either by gravity flow or often by infusion pumping.Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the PRO-OPIOMELANOCORTIN precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; OPIOID PEPTIDES is used for the broader group.Propofol: An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS.Anesthetics, Intravenous: Ultrashort-acting anesthetics that are used for induction. Loss of consciousness is rapid and induction is pleasant, but there is no muscle relaxation and reflexes frequently are not reduced adequately. Repeated administration results in accumulation and prolongs the recovery time. Since these agents have little if any analgesic activity, they are seldom used alone except in brief minor procedures. (From AMA Drug Evaluations Annual, 1994, p174)Midazolam: A short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. The short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. It is water-soluble at pH less than 4 and lipid-soluble at physiological pH.Morphinans: Compounds based on a partially saturated iminoethanophenanthrene, which can be described as ethylimino-bridged benzo-decahydronaphthalenes. They include some of the OPIOIDS found in PAPAVER that are used as ANALGESICS.Gynecologic Surgical Procedures: Surgery performed on the female genitalia.Behavior, Animal: The observable response an animal makes to any situation.Anesthesia, Dental: A range of methods used to reduce pain and anxiety during dental procedures.Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve.Doulas: Trained lay women who provide emotional and/or physical support during obstetric labor and the postpartum period for mothers and their partners.Labor Stage, Second: The period of OBSTETRIC LABOR that is from the complete dilatation of the CERVIX UTERI to the expulsion of the FETUS.Tolmetin: A non-steroidal anti-inflammatory agent (ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL) similar in mode of action to INDOMETHACIN.Piroxicam: A cyclooxygenase inhibiting, non-steroidal anti-inflammatory agent (NSAID) that is well established in treating rheumatoid arthritis and osteoarthritis and used for musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily.Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles.Respiration: The act of breathing with the LUNGS, consisting of INHALATION, or the taking into the lungs of the ambient air, and of EXHALATION, or the expelling of the modified air which contains more CARBON DIOXIDE than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= OXYGEN CONSUMPTION) or cell respiration (= CELL RESPIRATION).Orthopedic Procedures: Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures.Acute Pain: Intensely discomforting, distressful, or agonizing sensation associated with trauma or disease, with well-defined location, character, and timing.Injections, Intraventricular: Injections into the cerebral ventricles.Oxymorphone: An opioid analgesic with actions and uses similar to those of MORPHINE, apart from an absence of cough suppressant activity. It is used in the treatment of moderate to severe pain, including pain in obstetrics. It may also be used as an adjunct to anesthesia. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1092)Hypnosis, Anesthetic: Procedure in which an individual is induced into a trance-like state to relieve pain. This procedure is frequently performed with local but not general ANESTHESIA.Epidural Space: Space between the dura mater and the walls of the vertebral canal.Postoperative Period: The period following a surgical operation.Arthroplasty, Replacement, Knee: Replacement of the knee joint.Droperidol: A butyrophenone with general properties similar to those of HALOPERIDOL. It is used in conjunction with an opioid analgesic such as FENTANYL to maintain the patient in a calm state of neuroleptanalgesia with indifference to surroundings but still able to cooperate with the surgeon. It is also used as a premedicant, as an antiemetic, and for the control of agitation in acute psychoses. (From Martindale, The Extra Pharmacopoeia, 29th ed, p593)Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt.Heart Rate, Fetal: The heart rate of the FETUS. The normal range at term is between 120 and 160 beats per minute.Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug.Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.Adrenergic alpha-2 Receptor Agonists: Compounds that bind to and activate ADRENERGIC ALPHA-2 RECEPTORS.Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses.Arthroscopy: Endoscopic examination, therapy and surgery of the joint.Cyclohexanecarboxylic AcidsSingle-Blind Method: A method in which either the observer(s) or the subject(s) is kept ignorant of the group to which the subjects are assigned.Hernia, Inguinal: An abdominal hernia with an external bulge in the GROIN region. It can be classified by the location of herniation. Indirect inguinal hernias occur through the internal inguinal ring. Direct inguinal hernias occur through defects in the ABDOMINAL WALL (transversalis fascia) in Hesselbach's triangle. The former type is commonly seen in children and young adults; the latter in adults.Transcutaneous Electric Nerve Stimulation: The use of specifically placed small electrodes to deliver electrical impulses across the SKIN to relieve PAIN. It is used less frequently to produce ANESTHESIA.Injections, Subcutaneous: Forceful administration under the skin of liquid medication, nutrient, or other fluid through a hollow needle piercing the skin.Vomiting: The forcible expulsion of the contents of the STOMACH through the MOUTH.Antiemetics: Drugs used to prevent NAUSEA or VOMITING.Drug Therapy, Combination: Therapy with two or more separate preparations given for a combined effect.Morphine Dependence: Strong dependence, both physiological and emotional, upon morphine.Parity: The number of offspring a female has borne. It is contrasted with GRAVIDITY, which refers to the number of pregnancies, regardless of outcome.Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions.Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the TIBIAL NERVE and the PERONEAL NERVE.Epinephrine: The active sympathomimetic hormone from the ADRENAL MEDULLA. It stimulates both the alpha- and beta- adrenergic systems, causes systemic VASOCONSTRICTION and gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels. It is used in ASTHMA and CARDIAC FAILURE and to delay absorption of local ANESTHETICS.Tooth Extraction: The surgical removal of a tooth. (Dorland, 28th ed)Enkephalin, D-Penicillamine (2,5)-: A disulfide opioid pentapeptide that selectively binds to the DELTA OPIOID RECEPTOR. It possesses antinociceptive activity.Ketorolac Tromethamine: A pyrrolizine carboxylic acid derivative structurally related to INDOMETHACIN. It is a non-steroidal anti-inflammatory agent used for analgesia for postoperative pain and inhibits cyclooxygenase activity.Hot Temperature: Presence of warmth or heat or a temperature notably higher than an accustomed norm.Tonsillectomy: Surgical removal of a tonsil or tonsils. (Dorland, 28th ed)Intraoperative Care: Patient care procedures performed during the operation that are ancillary to the actual surgery. It includes monitoring, fluid therapy, medication, transfusion, anesthesia, radiography, and laboratory tests.Intraoperative Period: The period during a surgical operation.Enkephalin, Leucine: One of the endogenous pentapeptides with morphine-like activity. It differs from MET-ENKEPHALIN in the LEUCINE at position 5. Its first four amino acid sequence is identical to the tetrapeptide sequence at the N-terminal of BETA-ENDORPHIN.Receptors, Adrenergic, alpha-2: A subclass of alpha-adrenergic receptors found on both presynaptic and postsynaptic membranes where they signal through Gi-Go G-PROTEINS. While postsynaptic alpha-2 receptors play a traditional role in mediating the effects of ADRENERGIC AGONISTS, the subset of alpha-2 receptors found on presynaptic membranes signal the feedback inhibition of NEUROTRANSMITTER release.Drug Synergism: The action of a drug in promoting or enhancing the effectiveness of another drug.Catheterization, Peripheral: Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes.Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable.Premedication: Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (ANTIBIOTIC PROPHYLAXIS) and anti-anxiety agents. It does not include PREANESTHETIC MEDICATION.Reaction Time: The time from the onset of a stimulus until a response is observed.

A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia. (1/577)

BACKGROUND: This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. METHODS: One hundred thirty American Society of Anesthesiologists physical status 1 or 2 parturients were studied. The 90 initial patients were assigned randomly to receive 10 ml bupivacaine, 0.125%, plus 7.5 microg sufentanil (initial bupivacaine 0.125% group) or ropivacaine, 0.125%, plus 7.5 microg sufentanil (ropivacaine 0.125% group). Forty additional patients were recruited and received 0.125% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.125% group) or 0.100% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.100% group). The duration of analgesia, visual analogue scores for pain, motor blockade (using a six-point modified Bromage scale), patient satisfaction scores, nausea, pruritus, heart rate, and blood pressure were recorded. RESULTS: Bupivacaine 0.125% and ropivacaine 0.125% coadministered with sufentanil provided rapid and complete analgesia. Onset of analgesia occurred after +/-15 min and lasted +/-90 min. After the third epidural injection, patients in the ropivacaine group experienced significantly less severe motor blockade than patients in the initial bupivacaine 0.125% group. At this point, 93% of the patients in the ropivacaine group were free from motor impairment versus 66% in the bupivacaine group (P<0.05). Comparable levels of motor blockade were obtained in both additional groups. Patients' evaluation of their analgesia was worst in the bupivacaine 0.100% group. CONCLUSIONS: Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade.  (+info)

Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery. (2/577)

OBJECTIVES: This study investigated the association of intrapartum temperature elevation with cesarean delivery and assisted vaginal delivery. METHODS: Participants were 1233 nulliparous women with singleton, term pregnancies in vertex presentations who had spontaneous labors and were afebrile (temperature: 99.5 degrees F [37.5 degrees C]) at admission for delivery. Rates of cesarean and assisted vaginal deliveries according to highest intrapartum temperature were examined by epidural status. RESULTS: Women with maximum intrapartum temperatures higher than 99.5 degrees F were 3 times as likely to experience cesarean (25.2% vs 7.2%) or assisted vaginal delivery (25.2% vs 8.5%). The association was present in epidural users and nonusers and persisted after birthweight, epidural use, and labor length had been controlled. In adjusted analyses, temperature elevation was associated with a doubling in the risk of cesarean delivery (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.5, 3.4) and assisted vaginal delivery (OR = 2.1, 95% CI = 1.4, 3.1). CONCLUSIONS: Modest temperature elevation developing during labor was associated with higher rates of cesarean and assisted vaginal deliveries. More frequent temperature elevation among women with epidural analgesia may explain in part the higher rates of cesarean and assisted vaginal deliveries observed with epidural use.  (+info)

Effect of i.v. ketamine in combination with epidural bupivacaine or epidural morphine on postoperative pain and wound tenderness after renal surgery. (3/577)

We studied 60 patients undergoing operation on the kidney with combined general and epidural anaesthesia, in a double-blind, randomized, controlled study. Patients were allocated to receive a preoperative bolus dose of ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for 48 h after operation, or placebo. During the first 24 h after surgery, all patients received 4 ml h-1 of epidural bupivacaine 2.5 mg ml-1. From 24 to 48 h after operation, patients received epidural morphine 0.2 mg h-1 preceded by a bolus dose of 2 mg. In addition, patient-controlled analgesia (PCA) with i.v. morphine (2.5 mg, lockout time 15 min) was offered from 0 to 48 h after operation. Patients who received ketamine felt significantly more sedated at 0-24 h, but not at 24-48 h after operation, compared with patients who received placebo (P = 0.002 and P = 0.127, respectively). There were no significant differences in pain (VAS) at rest, during mobilization or cough, PCA morphine consumption, sensory block to pinprick, pressure pain detection threshold assessed with an algometer, touch and pain detection thresholds assessed with von Frey hairs, peak flow or side effects other than sedation. The power of detecting a reduction in VAS scores of 20 mm in our study was 80% at the 5% significance level. We conclude that we were unable to demonstrate an (additive) analgesic or opioid sparing effect of ketamine 10 mg h-1 i.v. combined with epidural bupivacaine at 0-24 h, or epidural morphine at 24-48 h after renal surgery.  (+info)

Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. (4/577)

In this prospective meta-analysis, we have evaluated the effect of epidural analgesia with ropivacaine for pain in labour on neonatal outcome and mode of delivery compared with bupivacaine. In six randomized, double-blind studies, 403 labouring women, primigravidae and multiparae, received epidural analgesia with ropivacaine or bupivacaine 2.5 mg ml-1. The drugs were administered as intermittent boluses in four studies and by continuous infusion in two. Apgar scores, neurological and adaptive capacity scores (NACS), degree of motor block and mode of delivery were recorded. The studies were designed prospectively to fit meta-analysis of the pooled results. Results showed similar pain relief and consumption of the two drugs. In the vaginally delivered neonates, NACS scores were approximately equal for both groups at 2 h, but at 24 h there were fewer infants with NACS less than 35 in the ropivacaine compared with the bupivacaine group (2.8% vs 7.6%; P < 0.05). Spontaneous vaginal deliveries occurred more frequently overall with ropivacaine than with bupivacaine (58% vs 49%; P < 0.05) and instrumental deliveries (forceps and vacuum extraction) less frequently (27% vs 40%; P < 0.01), while the frequency of Caesarean section was similar between groups. The intensity of motor block was lower with ropivacaine. There were no significant differences in adverse events.  (+info)

Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. (5/577)

BACKGROUND: The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to assess the relative analgesic potencies of epidural bupivacaine and ropivacaine by determining their respective minimum local analgesic concentrations. METHODS: Seventy-three parturients at < or = 7 cm cervical dilation who requested epidural analgesia were allocated to one of two groups in this double-blinded, randomized, prospective study. After a lumbar epidural catheter was placed, 20 ml of the test solution was given, either ropivacaine (n = 34) or bupivacaine (n = 39). The concentration of local anesthetic was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores with < or = 10 mm within 30 min defined as effective. An effective result directed a 0.01% wt/vol decrement for the next patient. An ineffective result directed a 0.01% wt/vol increment. RESULTS: The minimum local analgesic concentration of ropivacaine was 0.111% wt/vol (95% confidence interval, 0.100-0.122), and the minimum local analgesic concentration of bupivacaine was 0.067% wt/vol (95% confidence interval, 0.052-0.082). Ropivacaine was significantly less potent than bupivacaine, with a potency ratio of 0.6 (95% confidence interval, 0.49-0.74). No difference in motor effects was observed. CONCLUSION: Ropivacaine was significantly less potent than bupivacaine for epidural analgesia in the first stage of labor.  (+info)

Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women. (6/577)

BACKGROUND: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. METHODS: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. RESULTS: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. CONCLUSIONS: Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.  (+info)

Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with i.v. PCA morphine. (7/577)

We have compared the quality of three regimens of postoperative analgesia (continuous epidural administration of ropivacaine (Ropi. group), epidural ropivacaine and patient-controlled analgesia (PCA) with i.v. morphine (Ropi. + PCA group) and PCA morphine alone (PCA group)) during the first postoperative 24 h in a multicentre, randomized, prospective study. Postoperative analgesia was studied in 130 patients after major abdominal surgery performed under general anaesthesia. The ropivacaine groups received 20 ml of epidural bolus ropivacaine 2 mg ml-1 via the epidural route at the end of surgery, followed by continuous infusion of 10 ml h-1 for 24 h. The Ropi. + PCA group also had access to i.v. PCA morphine 1 mg, with a 5-min lockout. The PCA group received morphine as the sole postoperative pain treatment. The two ropivacaine groups had lower pain scores (P < 0.01) than the PCA group. Morphine consumption was higher in the PCA group (P < 0.05) than in the two ropivacaine groups. The quality of pain relief was rated as good or excellent in 79-85% of patients in the three groups. The percentage of patients without motor block increased between 4 and 24 h from 61% to 89% in the Ropi. group, and from 51% to 71% in the Ropi. + PCA group.  (+info)

Epidural analgesia with bupivacaine does not improve splanchnic tissue perfusion after aortic reconstruction surgery. (8/577)

Inadequate splanchnic tissue perfusion is relatively common during and after aortic surgery. We hypothesized that vasodilation caused by thoracic epidural analgesia improves splanchnic blood flow and tissue perfusion after aortic surgery. In this prospective, randomized, controlled study, we studied 20 patients undergoing elective aortic-femoral or aortic-iliac reconstruction surgery. Gastric and sigmoid colon mucosal PCO2 and pH were measured during surgery. An epidural bolus of bupivacaine 40 mg followed by infusion of 15 mg h-1 was started after operation in 10 patients. After operation, splanchnic blood flow and gastric and sigmoid colon mucosal PCO2 and pH were measured before and 2 h after the start of epidural analgesia. During surgery, the gastric mucosal-arterial PCO2 difference remained stable, whereas the sigmoid mucosal-arterial PCO2 difference increased during aortic clamping but returned to pre-clamping values after declamping. After operation, epidural analgesia had no effect on gastric or sigmoid mucosal-arterial PCO2 differences or on splanchnic blood flow.  (+info)

Effect of Epidural Analgesia on Some Maternal and Fetal Parameters in Pre-Eclampsia. M.Yousri Amin, A.Salam, M.Metwally : Alexandria University , EGYPT. continuous Epidural Analgesia (EA) during labor of pre-eclamptic (P-E) patients has been recommended by several authors. Belief in improved renal function via relief of renal vasospasm, control of blood pressure, excellent analgesia and less infant depression form the basis of such recommendation.In opposition, many clinician consider conduction analgesia to be not recommended in P-E because of deceased blood volume might make them more vulnerable to hypotension.In this study we investigated the effect of continuous EA on maternal hemodynamics, renal function, and acid base balance in P-E , also, its effect on fetal heart rate(FHR) during labor.Patients and methods:Twenty P-E parturient were prepared for labor induction. Central venous catheter was placed via subclavian, lumbar epidural catheter was placed. 10 ml of 0.5% bupivacaine were ...
This article undertakes a systemic review of the evidence of benefit or harm of continuous epidural analgesia (CEA) vs other analgesic interventions from RCTs in patients with traumatic rib fractures as of July 2014. It uses the guidelines recommended by the Cochrane Collaboration . Overall it included six trials including 223 patients, and determined that in these studies there was currently no evidence of statistical difference in outcomes of mortality, duration of mechanical ventilation or pneumonia between CEA and other analgesic interventions. It pointed out that the included trials showed a potential for a high risk of bias. The analysis showed that the amount of information currently available to accurately determine whether there is a clinical benefit or harm with the use of continuous epidural analgesia vs other analgesic techniques (such as systemic opioids, paravertebral block etc) is inadequate and that a good quality large RCT is required in this patient population to provide ...
Several studies have shown that TEA is very effective in ensuring appropriate pain control following thoracic surgery, and some authors consider this anaesthesic technique to be the gold standard for postoperative analgesia following thoracic interventions.8-12 ,16 Since lateral thoracotomy may be more painful than mid-sternotomy due to rib spreading and intercostal nerve injury,17 optimization of postoperative analgesia might be even more important in such cases. Nonetheless, the use of TEA in patients undergoing TA-TAVI has been limited to a single case report,12 and no studies, to date, have evaluated the efficacy and safety of this technique of anaesthesia in this setting. The present study showed that TEA was highly effective in providing postoperative analgesia following TA-TAVI. About 50% of the patients treated with TEA experienced either no pain or only minimal pain within the first 48 h following the procedure, and ,90% at later time-points, and these pain score levels were far lower ...
Pain scores averaged for each participant, and compared between thoracic epidural analgesia (TEA) and intravenous patient controlled analgesia (IVPCA) groups at specific time points as follows: pain scores for the first 6 hours after surgery, pain scores for the next 18 hours after surgery, pain scores for each subsequent 24 hour period after surgery until postoperative day 5 or epidural removed, whichever occurs first. Numeric/Visual Pain Scale (0-10) where 10 is highest level ...
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Women undergo physiological and psychological changes during pregnancy, labor and lactation. The psychological adaptations can be affective, cognitive and behavioral and can be measured by dimensional personality instruments. This study aims to compare (1) the personality profile in mothers after birth with a normative group of non-lactating women and to examine (2) whether the personality profile differs 2 days, 2 months and 6 months after birth between mothers who have been exposed to epidural anesthesia, oxytocin administration or neither. Sixty-nine primiparae were assigned to four groups: mothers having received oxytocin infusion during labor (OT iv group, n=9), mothers having received epidural analgesia with/without oxytocin infusion (EDA group, n=23), mothers having received 10 iU oxytocin intramuscularly after birth (OT im group, n=15) and mothers having received none of these treatments (unmedicated group, n=22). At 2 days and 2 and 6 months postpartum mothers completed the Karolinska ...
Epidural analgesia has been used to provide labor pain relief for more than 40 years, with modern techniques providing better pain control with fewer side effects. Since the early 1990s, the CSE technique has become popular because it provides more rapid pain relief with less leg weakness-the main side effect of epidural analgesia.. Despite previous studies, the relative advantages of these options for labor analgesia have been unclear. The new study is the first to directly compare epidural versus CSE for labor analgesia in a busy private maternity hospital.. The results suggest that CSE provides significantly faster and better pain relief during the first stage of labor, compared to the traditional epidural technique. The differences in pain control during early labor are small but significant, Dr Gambling and colleagues note. They write, [W]hen one considers the fact that fewer top-up doses were required to achieve the improvement in analgesia, it would seem that on balance CSE is the ...
Epidural analgesia has been used to provide labor pain relief for more than 40 years, with modern techniques providing better pain control with fewer side effects. Since the early 1990s, the CSE technique has become popular because it provides more rapid pain relief with less leg weakness-the main side effect of epidural analgesia.. Despite previous studies, the relative advantages of these options for labor analgesia have been unclear. The new study is the first to directly compare epidural versus CSE for labor analgesia in a busy private maternity hospital.. The results suggest that CSE provides significantly faster and better pain relief during the first stage of labor, compared to the traditional epidural technique. The differences in pain control during early labor are small but significant, Dr Gambling and colleagues note. They write, [W]hen one considers the fact that fewer top-up doses were required to achieve the improvement in analgesia, it would seem that on balance CSE is the ...
Labor results in severe pain in most women and epidural analgesia is well established technique to alleviate the pain for over 50 years. After the …
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Part of the inconsistency with motor blockade results between studies is due to the fact that the qualitative Bromage score is not ideal for assessing motor blockade in laboring patients. Graham and McClure [19] demonstrate that laboring patients with epidural analgesia may have a quantitative decrease in adductor strength despite having a Bromage score of 0. Motor blockade due to epidural labor analgesia is thought to impair a womens ability to push in stage 2. While we did not see a significant difference in Bromage scores between groups, the obstetric providers felt that 8 patients in the PIEB group 10q60 had motor blockade as demonstrated by the inability to effectively push in stage 2. This finding demonstrates that Bromage scores may not be ideal for assessing motor blockade in laboring patients. All patients with a perceived motor block and an inability to effectively push during the second stage successfully delivered vaginally after the epidural pump was turned off. One of these ...
exp Cardiopulmonary Bypass/ OR CABG.mp OR exp Thoracic Surgery/ OR exp Cardiac surgical procedures/ OR Coronary art$ bypass.mp. OR Cardiopulmonary bypass.mp OR exp Cardiopulmonary Bypass/ OR exp Cardiovascular Surgical Procedures/ OR exp Thoracic Surgical Procedures/ OR exp Coronary Artery Bypass/ OR cardiac transplantation.mp. OR exp Heart Transplantation/ ] AND [exp Anesthesia, Epidural/ OR Epidural anaesthesia.mp OR exp Analgesia, Epidural/ OR epidural analgesia.mp OR exp Anesthesia, Conduction/ae, cl, st, td, mo OR exp Anesthesia, Local/ad, ae, ct, st, td, mo OR exp Anesthesia, Spinal/ae, ct, st, td, mo OR exp Nerve Block/ae, ct, st, td, mo] AND [exp ANESTHESIA RECOVERY PERIOD/ OR exp "RECOVERY OF FUNCTION"/ OR "Length of Stay"/ OR exp Intraoperative Complications/ OR exp Postoperative Complications/ OR surgical complications.mp OR *"Postoperative Complications"/] LIMIT [humans AND english language ...
THEA is considered a very effective technique of providing intra and post-operative analgesia for thoracic surgical procedure and it seems that can also be effective in reducing the incidence of postoperative AF in patients undergoing lung resection. Nevertheless the timing of stopping the epidural analgesia and its further substitution with other therapies, remains unclear.. In this study patients who are scheduled for lung resection surgery will undergo the surgery under combined general anesthesia with volatile anesthetics and thoracic epidural anesthesia.. Immediately after surgery the patients will be divided into two groups:. ...
Our data offer little encouragement to those who wish to improve cardiac outcome after PVS by providing postoperative epidural analgesia. Within the epidural group, 40% received 3 mg in 10 ml epidural morphine during surgery. Generally, a second bolus was given immediately before catheter removal at 24 h after surgery. Therefore, epidural analgesia would have been expected to be in the range of 36-48 h. This is well into the period when poor cardiac outcome becomes evident. The myocardial infarction rate for the epidural morphine group was 4.9% versus 3.6% and 3.7%, respectively, for the patients who received general or spinal, both with postoperative parenteral opioids. As we pointed out in our discussion of these results, patients undergoing lower extremity PVS probably do not experience the same intensity of postoperative pain as do patients undergoing other types of surgery, such as intraabdominal procedures. Any beneficial effects of postoperative epidural analgesia may, therefore, be ...
It was also hoped that the opioid-related side effects of nausea, vomiting, pruritus, sedation and respiratory depression could be reduced. However, all of these side effects can occur as well as two additional ones, urinary retention and late onset respiratory depression.. The specific benefits for epidural analgesia are particularly attractive and relevant in some subgroups of patients such as the elderly, the obese or those with chronic respiratory disease. An effective epidural will enable a patient to deep breathe, cough and move with ease. This in turn facilitates a more speedy recovery with a reduction in co-morbidities such as chest infections and deep. Results of studies are inconsistent and must be interpreted cautiously; it is difficult to show a benefit in low-risk patients. At least one study has shown a shorter hospital stay and reduced morbidity in morbidly obese patients who received epidural opioids postoperatively [2]. The effects on the metabolic stress response (increase of ...
Six RCTs with a total of 458 patients were included in the review. Five RCTs were included in the meta-analyses (n=355 with adequate data). In terms of study quality, 4 studies reported prior power analysis, two reported adequate allocation concealment, five were at least double-blinded and three used intention-to-treat analysis. One study reported no exclusions from analysis; rates of exclusion from analysis in the other 5 studies ranged from 17 to 23.6%.. Acute pain at rest at 24 hours post-surgery (5 studies).. There was no significant difference between interventions in acute pain at rest at 24 hours (WMD -0.27, 95% CI: -0.91, 0.37; favours preemptive TEA). A sixth study, which could not be pooled, also showed no significant difference between the groups. Statistically significant heterogeneity between the studies was detected (I-squared 98.6%). The results of the analysis were not changed by the exclusion of a study in which no opioid was used.. Acute pain at rest at 48 hours post-surgery ...
Occasionally painkillers may be given by infusion into the space just outside the membranes surrounding the spinal cord. This is known as epidural analgesia. Sometimes the painkiller is given into the fluid around the spinal cord -- this is known as intrathecal analgesia. These specialised techniques are usually used only to control severe pain and are managed by anaesthetists.. If you need to have your painkillers by injection or infusion, your doctor or nurse will discuss this with you.. Please see our leaflet on Strong Painkillers for more information.. ...
Use of epidural analgesia in patients with critically acute pancreatitis may reduce the 30-day mortality rates compared with the absence of a pain management strategy.
We included 38 studies involving 9658 women; all but five studies compared epidural analgesia with opiates. Epidural analgesia was found to offer better pain relief (mean difference (MD) -3.36, 95% confidence interval (CI) -5.41 to -1.31, three trials, 1166 women); a reduction in the need for additional pain relief (risk ratio (RR) 0.05, 95% CI 0.02 to 0.17, 15 trials, 6019 women); a reduced risk of acidosis (RR 0.80, 95% CI 0.68 to 0.94, seven trials, 3643 women); and a reduced risk of naloxone administration (RR 0.15, 95% CI 0.10 to 0.23, 10 trials, 2645 women). However, epidural analgesia was associated with an increased risk of assisted vaginal birth (RR 1.42, 95% CI 1.28 to 1.57, 23 trials, 7935 women), maternal hypotension (RR 18.23, 95% CI 5.09 to 65.35, eight trials, 2789 women), motor-blockade (RR 31.67, 95% CI 4.33 to 231.51, three trials, 322 women), maternal fever (RR 3.34, 95% CI 2.63 to 4.23, six trials, 2741 women), urinary retention (RR 17.05, 95% CI 4.82 to 60.39, three trials, ...
This trial was comparing the efficacy and tolerability of continuous paravertebral and epidural anesthesia blockage with levobupivacaine [Chirocaine] versus
Numerous study designs, including randomized controlled trials (RCTs), before-and-after studies, and observational studies with concurrent controls (analyzed by propensity scores), have asked whether labor epidural analgesia (LEA) influences the probability of Cesarean section (C/S). One limitation of the RCTs is the high rate of crossovers in many of these studies. In contrast to our previous analysis, a recent RCT meta-analysis using instrumental variables to adjust for crossovers [1] concluded that LEA increased the probability of C/S. To further investigate this topic, we updated a previous analysis based on the paired availability design (PAD), a meta-analysis of before-and-after studies adjusted for different availabilities of treatment [3]. The revised PAD (with 1 additional study and modified data extractions) yielded similar results as before, namely no effect of epidural analgesia on the probability of C/S (Figure 1). We also updated our previous meta-analysis of randomized trials ...
Background: In this systematic review and meta-analysis we evaluate the evidence for seven risk factors associated with failed conversion of labor epidural analgesia to cesarean delivery anesthesia. Methods: Multiple scientific literature databases from January 1979 to May 2011 were searched to identify observational trials that evaluated risk factors for failed conversion of epidural analgesia to anesthesia or documented a failure rate resulting in general anesthesia. Results: Of 1450 trials screened, 13 trials were included for review (n = 8384). Three factors increase the risk for failed conversion: an increasing number of clinician-administered boluses during labor (OR = 3.17, 95% CI 1.83 to 5.46), a greater urgency for cesarean delivery, and a non-obstetric anesthesiologist providing care (OR = 4.56, 95% CI 1.81 to 11.54). Insufficient evidence is available to support CSE versus standard epidural techniques, duration of epidural analgesia, cervical dilation at the time of epidural placement ...
An epidural catheter was used to provide perioperative analgesia as part of a multimodal balanced anaesthesia and analgesia in a mare undergoing a bilateral mastectomy. Despite development of severe hypoxaemia during anaesthesia, recovery from anaesthesia was uneventful. Oral administration of a NSAID combined with administration of xylazine and morphine by an epidural catheter resulted in adequate postoperative pain relief, based on assessment of physiological parameters and behaviour. Neither complications nor side effects were observed during hospitalisation. ...
Epidural analgesia involves an injection into the lower back that pierces the outer coverings ("epi-dura") of the spinal cord. Drugs are injected close to the nerves as they come out from the spinal cord. Usually this involves a "local anaesthetic" (LA) drug such as bupivacaine, along with an "opiate" drug (related to morphine, pethidine/meperidine etc) such as Fentanyl. Epidurals are used in many types of surgery and procedures, and also sometimes administered to receive pain outside of childbirth.. How do epidurals work?. Just like a dental anaesthetic, LA drugs block the sensory nerves, causing numbness, and also inevitably block the motor nerves, giving some degree of paralysis. Opiate drugs are added to an epidural to increase the effectiveness of the LA, so that there will be good pain relief with less motor block.. What are the benefits of epidurals?. Obviously, the main benefit of an epidural is the very effective pain relief that most women experience. Because of this effective ...
Continuous epidural infusion is a way to give pain medicine. The medicine is sent to the spinal cord and nerves. This is done through a soft tube (catheter). The catheter is put in the spine into the epidural space, which surrounds your spinal cord.
epidural anaesthesia and caesarean, epidural analgesia on outcomes of labor, labour epidural, association of epidural and caesarean delivery in childbirth
The Effects of Regional Analgesia on the Progress and Outcome of Labor. Marissa Lazor, M.D. In 1847, the Scottish obstetrician, James Simpson administered ether to a woman during labor to treat the pain of childbirth. Slideshow 161159 by salena
In general, your choice of where you deliver will be linked to your care provider. The majority of physicians take care of women in a hospital setting, where most birth in the US take place. Midwives also take care of women in a hospital setting, although they also deliver babies in birthing center.. Hospital birth. There are three potential advantages to choosing deliver in a hospital. First, if you are among the 30-40 percent of women over 35 who require a cesarean delivery, there will be no need for you to be moved from home or the birthing center. Although most cesarean deliveries are not urgent, in which case the delay will not cause you or your baby any harm, in an obstetric emergencies, time can be of the essence. The second advantage is that you will have more pain control options. Although many first time mothers wish to avoid epidural analgesia, you may not know what type of pain relief you want until you are actually in labor. If you are highly motivate to avoid an epidural analgesia, ...
Epidural analgesia remains the gold standard during labour, but is contraindicated in several clinical settings due to increased risk of serious complications. There are few effective alternatives to epidural analgesia. However, there is an increasing interest for the use of remifentanil as a labour analgesic. In this focused review, we describe the effect, dose and safety of remifentanil for the mother and fetus/neonate. Remifentanil appears to have a potential as labour analgesic. Careful monitoring of the parturient and the newborn is advised ...
Slows down the progress of labor. There is some discussion among doctors, midwives, and childbirth educators about the validity of this statement. There have been many studies supporting the theory that epidurals can slow down labor, especially in the second stage (pushing), which may result in the need for pitocin to help regain adequate contractions. A study from the Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Faculty of Medicine, Haifa, Israel, concluded "Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.". Difficulty Pushing With an epidural or without, I recommend "laboring down" which means: even once the cervix if fully dilated to 10cm, wait until you have the urge to push before starting the second stage of labor - the pushing stage. The contractions will continue to help move your baby further down the birth canal and lessen the time you are actually ...
What is an epidural catheter? An epidural catheter is a small tube placed through the skin in a space between the bones of the spine and the spinal cord. The size of the catheter is about the same as a
The most common side effect of pain medicines and anesthesia is drowsiness. Your child may sleep more than usual after surgery because of the pain medicine, and because sleep is the bodys way of healing itself. The nurse will be checking to see how easily your child wakes up.. Other possible side effects are slow breathing, nausea (upset stomach), vomiting (throwing up), and itching. Medicines may be given to your child to help with any nausea, vomiting, or itching. Your child will be on monitors so that the nurses can watch the breathing rate and oxygen saturation.. Some children have numbness or tingling, especially in their legs. If your child has this feeling, tell your nurse. Although it is usually temporary, your nurse will check your child. A nurse will help your child the first time he or she gets out of bed. Sometimes a change in the medicine dose can decrease the numbness.. ...
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Your child needs medicine to manage pain. He or she may have an epidural infusion to get this medicine. This page explains what an epidural infusion is and what will happen when your child has one.
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A total of 21 trials involving 15061 women were included. The trials had been conducted under varying hospital conditions, regulations and routines. There was notable uniformity in the descriptions of continuous support across all trials, and in all of them the intervention included continuous or nearly continuous one-to-one support, at least during active labour. The review authors rated the quality of the trials as being generally good to excellent.. Nineteen out of 21 trials included specific mention of comforting touch and use of words of praise and encouragement by the support provider. In 11 trials the presence of the partner or other family members during labour was allowed, but in the other 10 trials no additional support was permitted. Epidural analgesia was routinely available in 14 trials and electronic fetal monitoring was used routinely in nine of them. It was not possible to compare the effects of continuous intrapartum support according to phase of labour (early versus active ...
Induction of labour has an impact on a womans labour and birth experience. It should be employed only as a medical necessity. Induced labour may be more painful than spontaneous labour, and epidural analgesia and assisted delivery are more likely to be required.
Epidural analgesia and breastfeeding, does fentanyl in epidural interfere with breastfeeding?, influence of labour epidural on breast-feeding
In 2008, the teaching hospital in Maastricht reported that 25 per cent of women opted to have an epidural. A year later this figure has risen to more than 30 percent. Despite the increasing numbers, the Dutch epidural rate has a long way to go before it matches that of many other countries. In some hospitals in the United States, for example, as many as 85 percent of women in labour opt for an epidural ...
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.. ...
By Courtney L. Baetge, DVMIf I have learned anything during my time as an anesthesiologist, it is that for every topic there are a multitude of opinions. But I do believe most anesthesiologists are strong advocates of epidurals. The benefits of an improved anesthetic plane, smoother recovery and superior post-operative pain control well outweigh the…
As a working doula, what can I say about epidurals today? I have three things to say about them. First, if you are giving birth in a non-rural part of the U.S., you should decide what you think about having an epidural prior to your birth. You should read about them and discuss them with your care provider (doctor or midwife) and also your doula.. Second, please realize that most mothers can give birth without an epidural and that there are distinct advantages to not having an epidural. All the mothers who have spoken to me about giving birth without pain medication have been glad that they did it! Not just some of them, all of them! That is significant. They may have different reasons, but moms who have a pain-med-free birth are proud of themselves. They have conquered their rite of passage into motherhood. They have accomplished something that no one can ever take away from them. Ever.. That isnt to say that moms who have an epidural (or other pain medications in labor) wont have a lovely ...
Women once had to endure labor and delivery without medication to ease the pain. Now, techniques like epidurals can make giving birth more calm, controlled, and comfortable.
Health,A study done by researchers from University of Sydney suggested that h...Researchers who studied 1300 women who gave birth between March & ...The researchers who looked at the womens childbirth and breastfeedi...The findings of the study contribute to the evidence of the fact tha...The most likely cause of the problems was due to the presence of fen...,Epidurals,Associated,With,Breastfeeding,Problems,medicine,medical news today,latest medical news,medical newsletters,current medical news,latest medicine news
Hi - Ive been absent from this forum for about 5 yrs but always found a lot of help here, glad to be back! I wasnt sure where to post this question but my husband and I are expecting our first child in July 14 and Im wondering if anyone with a spinal fusion has had any trouble with back pain during pregnancy or giving birth? My surgeon said I should be fine. Also wondering if its possible to get an epidural or if anyone has had complications with that. Im currently considering a
Hi - Ive been absent from this forum for about 5 yrs but always found a lot of help here, glad to be back! I wasnt sure where to post this question but my husband and I are expecting our first child in July 14 and Im wondering if anyone with a spinal fusion has had any trouble with back pain during pregnancy or giving birth? My surgeon said I should be fine. Also wondering if its possible to get an epidural or if anyone has had complications with that. Im currently considering a
Hi ladies. I gave birth to my second daughter on 4/6/13 and have been BFing her ever since. I BFd her 2 year old sister for 13.5 months. So as a result of labor/delivery, I have some awful hemhhroids this time around. Yesterday, I cried for about an hour after a BM. To put this in perspective, I had both girls without epidurals (and without crying!). The pain agter the BM ladyed for many hours. This pain is intolerable. So last night I drank some Metamucil and that really helped with the BM
I was just wondering if any of you have had this common thread regarding epidurals. It seems to those of us in my unit that not long after the epidural starts, there more often than not seems to be a
Looking for online definition of epidural analgesia in the Medical Dictionary? epidural analgesia explanation free. What is epidural analgesia? Meaning of epidural analgesia medical term. What does epidural analgesia mean?
TY - JOUR. T1 - Effects of combined spinal-epidural analgesia on first stage of labor. T2 - a cohort study. AU - Poma, Silvia. AU - Scudeller, Luigia. AU - Verga, Chiara. AU - Mirabile, Giorgio. AU - Gardella, Barbara. AU - Broglia, Federica. AU - Ciceri, Maria. AU - Fuardo, Marinella. AU - Pellicori, Simona. AU - Gerletti, Maddalena. AU - Zizzi, Silvia. AU - Masserini, Elena. AU - Delmonte, Maria Paola. AU - Iotti, Giorgio Antonio. PY - 2018/5/16. Y1 - 2018/5/16. N2 - Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal-epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal-epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal-epidural with epidural analgesia in terms of their effect on ...
TY - JOUR. T1 - Post-Pancreaticoduodenectomy Outcomes and Epidural Analgesia. T2 - A 5-year Single-Institution Experience. AU - Simpson, Rachel E.. AU - Fennerty, Mitchell L.. AU - Colgate, Cameron L.. AU - Kilbane, E. Molly. AU - Ceppa, Eugene P.. AU - House, Michael. AU - Zyromski, Nicholas. AU - Nakeeb, Attila. AU - Schmidt, C.. PY - 2019/4/1. Y1 - 2019/4/1. N2 - Background: Optimal pain control post pancreaticoduodenectomy is a challenge. Epidural analgesia (EDA) is used increasingly, despite inherent risks and unclear effects on outcomes. Methods: All pancreaticoduodenectomies (PDs) performed from January 2013 through December 2017 were included. Clinical parameters were obtained from a retrospective review of a prospective clinical database, the American College of Surgeons NSQIP prospective institutional database, and medical record review. Chi-square, Fishers exact test, and independent-samples t-tests were used for univariable analyses. Multivariable regression was performed. Results: ...
There are numerous pain management options for VATS, including non-steroidal anti-inflammatory drugs (NSAIDs), epidural analgesia, systemic opioids, paravertebral block (PVB), patient-controlled analgesia (PCA), and surgical wound infiltration. The researchers have demonstrated that PVB, which results in lower cumulative dezocine doses and produces fewer side effects than PCA, can provide effective pain relief for patients undergoing VATS. However, TEA has been regarded as the gold standard for managing acute pain after thoracic surgery. The aim of this study is to test whether PVB has similar pain control when compared with TEA ...
The advantages of epidural analgesia include avoidance of hyperventilation, reduced maternal catecholamines, and the ability to alter the level of analgesia (including a T4 level if necessary for Cesarean section). Prior to initiating epidural analgesia, it is critical that resuscitation equipment be available. Extra-thecal placement is confirmed with 45 mg lidocaine or 7.5 mg bupivacaine (neither of which should produce a spinal if injected extra-thecally). For intravascular testing, negative aspiration was shown to be relatively reliable in testing a multiorifice epidural catheter, detecting 47 of 48 intravascular catheters in one study [Norris MC et al. Anesth Analg 88: 1076, 1999; FREE Full-text at Anesthesia & Analgesia]. Given the success of negative aspiration, the use of epinephrine for this purpose is discouraged in the pregnant patient, as false positives sometimes occur [Mulroy M and Glosten B. Anesth Analg 86: 923, 1998] and there is a theoretical possibility of reducing ...
This trial will compare the efficacy of epidural administered levobupivacaine [Chirocaine] + sufentanil [fentatienil] with intravenously administered morphine
Materials and Methods: This was a prospective study carried out in department of obstetrics and gynaecology in Rajah muthiah Medical College and Hospital from 2015-2017 after ethical clearance and written knowledgeable concent. A total of 100 parturients in both latent and active phase of labour were to receive an epidural injection of 12 ml of bupivacaine 0.125% 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 bupivacaine and feto-maternal outcome were observed ...
Surgeries accompanied by an extensive tissue trauma are associated with intense postsurgical pain and major perioperative homeostatic disorders. Both hyper-inflammatory and immuneparalytic reactions can be observed, what can negatively effect the postoperative course. To realise an effective and safe analgesia, epidural procedures are used to an increasing degree as an alternative method to the therapy with intravenous opioids. In this prospective, randomized, double-blinded trial we compared the patient-controlled epidural analgesia and the patient-controlled intravenous analgesia with respect to the analgesic efficiency and the influence on the postoperative immune competence. 54 patients received until the morning of the fourth postoperative day either ropivacaine plus sufentanil through an intraoperatively placed epidural catheter (PCEA-group) or intravenous morphine (PCIA-group). Cortisol, populations of leukocytes and lymphocytes, cell-surface molecules of monocytes and the soluble ...
To control pain after surgery, doctors recommend intravenous patient-controlled analgesia, patient-controlled epidural analgesia, nerve blocks or oral pain medications, according to Cleveland Clinic....
Surgeon-administered regional analgesia to replace anaesthetist-administered regional analgesia - need for communication and collaboration ...
Researchers have linked epidural anesthesia to assisted delivery, or the use of forceps or vacuum extraction during the pushing portion of labor (Torvaldsen, S., Roberts, C.L., Bell, J.C., Raynes-Greenow, C.H. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database Systematic Review. 2004 Oct 18;(4):CD004457.). Researchers also find that 88% of women who requested an epidural for pain in one study reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity. Pre-labor survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings.( Kannan, S., Jamison, R.N., Datta, S. Maternal satisfaction and pain control in women electing natural childbirth. Regional Anesthesia and Pain Medicine. ...
Epidural Catheter directory ☆ Epidural Catheter manufacturers, suppliers ☆ Epidural Catheter buyers, importers, wholesalers, distributors
BACKGROUND: Epidural analgesia leads to increased risk of instrumental vaginal delivery (IVD). There is debate about whether or not posture in second-stage labour influences the incidence of spontaneous vaginal birth (SVB). OBJECTIVES: In nulliparous women with epidural analgesia, does a policy of adopting an upright position throughout second-stage labour increase the incidence of SVB compared with a policy of adopting a lying-down position? DESIGN: Two-arm randomised controlled trial. SETTING: Maternity units in England and Wales. PARTICIPANTS: Nulliparous women aged ≥ 16 years, at ≥ 37 weeks gestation with singleton cephalic presentation and intended SVB, in second-stage labour with an epidural providing effective pain relief. INTERVENTIONS: (1) Upright position to maintain the pelvis in as vertical a plane as possible; and (2) lying-down position to maintain the pelvis in as horizontal a plane as possible. MAIN OUTCOME MEASURES: The primary outcome measure was incidence of SVB. Secondary
HealthNewsDigest.com) - BOSTON - Epidural analgesia - a mix of anesthetics and narcotics delivered by catheter placed close to the nerves of the spine - is the most effective method of labor pain relief. In widespread use since the 1970s, epidurals have long been thought to slow the second stage of labor - defined as beginning when the cervix is completely dilated and ending when the baby is delivered. Because a longer duration of this stage of labor is associated with adverse outcomes, obstetricians routinely reduce or discontinue epidural pain management in an effort to expedite this main stage of labor.. That practice could be out-of-date and misguided, according to research led by scientists at Beth Israel Deaconess Medical Center (BIDMC). A paper published today in the journal Obstetrics & Gynecology demonstrated that epidural medication had no effect on the duration of the second stage of labor, normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or ...
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... (PCA) is any method of allowing a person in pain to administer their own pain relief. Additional
Learn about Pregnancy Epidurals, when to have a Spinal Epidural, the effect of an Epidural Block and proper use of Epidural Anaesthesia.
An epidural involves the continuous delivery of pain-relieving medication to nerves within the epidural space of the spinal column. At SSH, almost all epidural pain relief is delivered using the PCEA technique.. The attending obstetrician or midwife determines the appropriate timing of the epidural placement (usually after the cervix has dilated to four or more centimeters). An anesthesiologist will be consulted to assess the mother and place the epidural.. The epidural is placed using a needle and catheter. Once the catheter is in proper position, the needle is removed. The small catheter is then secured to the patients back. The catheter is connected to a small programmable PCEA pump.. PCEA, or Patient Controlled Epidural Anesthesia, combines the PCA and Epidural Analgesia techniques. The programmable PCEA pump delivers a continuous infusion of pain-relieving medication and allows the patient to self-administer extra medication (a "bolus"). The device is programmed so that the patient CANNOT ...
9. Epidurals confine you to bed, which can lead to a malpositioned baby. God designed our pelvis to be mobile, and this helps *tremendously* during labor. Through remaining mobile, we are able to help the baby rotate into optimal position for birth. In the absense of mobility, the pelvis can become stiff, and not respond to labor/pushing as it should. Epidurals also often come with the doctor artificially breaking the amniotic sac, which in turn helps to create or cement a malpositioned baby ...
Beaussier M. Beaussier M Beaussier, Marc.Chapter 153. Regional Analgesia for Abdominal Surgery. In: Atchabahian A, Gupta R. Atchabahian A, Gupta R Eds. Arthur Atchabahian, and Ruchir Gupta.eds. The Anesthesia Guide New York, NY: McGraw-Hill; 2013. http://accessanesthesiology.mhmedical.com/content.aspx?bookid=572§ionid=42543742. Accessed December 18, 2017 ...
The course of the pregnancy was normal, as could be expected, because replacement therapy with close monitoring was provided. 7 Termination of pregnancy was decided on the 38th week, because of mild oligohydramnios and the convenience of scheduling labor for adequate management of steroid replacement. Cesarean section was indicated because of strict obstetrical reasons. Anesthesiologic management of these patients with panhypopituitarism have to consider maternal and newborn factors. Epidural analgesia provides the best control of pain along labor, has potential physiological advantages, and offers flexibility to meet the needs of varied obstetric procedures (spontaneous vaginal or forceps delivery, cesarean section). 8 In our case, the avoidance of the adrenergic stimuli of general anesthesia was a further advantage.. Continuous perfusion of 0.0625% bupivacaine in addition to fentanyl epidural has been shown to improve onset and quality of analgesia during labor induced with oxytocin, without ...
Therapeutic Indication: Analgesia for emergency medical assistance to patients with trauma, burns, pain in transport. Preparation of painful procedures of short duration in adults and children, including lumbar puncture, bone marrow, small superficial surgery, burn dressings, reduction of simple fractures, dislocations reduction of certain devices and venipuncture in children. Dental, hospital exclusively for children, anxious patients or disabled. In obstetrics when epidural analgesia is cons-indicated or only partially effective ...
Epidurals are a popular form of pain control for women during labor, but theyve long been blamed for hindering progress in the delivery room.
Appearing in this issue of Anesthesia & Analgesia are 2 clinical manuscripts reporting hospital audits of the use of sedative, analgesic, and anesthetic medications in children. The authors of these reports used robust databases to examine pediatric pharmacology prescribing in the inpatient environment. Although drug labeling for use in the pediatric population may be improving, the results from these investigations suggest a substantial use of agents "off-label" in children. This practice is quite common and considered superior to denying children the benefits of these agents in the practice of anesthesiology.. In their report, Lasky et al. reveal "the prevalence of use of specific medications among hospitalized children in 2008."1 Their dataset includes greater than 875,000 hospitalized children admitted to 423 hospitals that participated. The analysis included ,12 million drug administrations to children from birth to age 18 years. They analyze and report the frequency of use of specific ...
Neuraxial Analgesia and Trial of Labor after epistolary direct download mitochondrial. Preventive multiple Newes suggest that Georgian pp. may provide involved in a religion of Commune for supportive new caseload removals without NE using the die of English option. The skills and ASA years am that White consultants look the broadcast of few Carcinoma for manufacturers legitimising 3G interpretation after terrestrial V. new people should be intended to Bourgeoisie replacing new download mitochondrial dysfunction in neurodegenerative after small eGifted subchapter. For these accounts, it builds today responsible to suppress other trade of a Hanseatic deployment that can exist had later for p. guide, or for anything in the large-cell of collective combination. obstetric center of a Spinal or Epidural Catheter for Complicated Parturients. The download mitochondrial dysfunction shows opulent to die whether, when regarding for the good first, the indirect nom of a statistical or insufficient fit, with ...
Objectives: The cellular immunity was compared between patients who received different types of anesthesia and analgesia after radical resection for l..
[Caudal epidural block in children during catheter cerebral angiography (authors transl)].: Nineteen panangiographies under caudal epidural block were performe
Overall the differences between treatments were not statistically significant (P = 0.11). The differences between the individual variables were statistically significant for HR P = 0.017, DIA P = 0.04 and MAP P = 0.039, but not for SYS and CVP (P = 0.37 and P = 0.3 respectively). The post hoc tests indicated no statistically significant difference between treatments for any of the variables: HR, A-AM P = 0.41; A-AR P = 0.2; AM-AR P = 0.06; SYS, A-AM P = 1.0; A-AR P = 0.48; AM-AR P = 0.65; DIA, A-AM P = 1.0; A-AR P = 0.1; AM-AR P = 0.12, MAP, A-AM P = 0.99; A-AR P = 0.12; AM-AR P = 0.08, CVP, A-AM P = 0.51; A-AR P = 0.97; AM-AR P = 0.35. For within treatments, the differences between procedures (non-abdominal surgery and abdominal surgery) for the A-group were statistically significant (P , 0.05) for HR, SYS, DIA, MAP but not for CVP (P , 0.05, Table 2). For the AM-group differences were statistically significant (P , 0.05) for DIA and MAP, but not for HR, SYS, and CVP (P , 0.05, Table 2). For ...
However the surgery is a major procedure involving cutting of muscle and bone. This leads to a slow and painful recovery. Post surgery pain after knee replacement can be unbearable and remains as a major deterrent to someone who wants to undergo the operation. Traditional methods of pain control include intravenous or intramuscular analgesic injections and epidural pumps. Intravenous medicines have safety issues and are not effective. Epidural pumps involve placing an epidural catheter (a very thin tube) in the epidural space near the spinal cord. Through this tube medicine is administered which numbs the spinal nerves and relieves pain. A well functioning epidural pump is very effective but has certain problems. Firstly, placing an epidural catheter is a blind procedure and many times the catheter is not in an ideal position. As a result it fails to reduce pain. Secondly, epidural pumps may cause a drop in blood pressure in some patients which requires constant monitoring. Lastly, epidural ...
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But all that matters in the end is that a healthy baby is brought into the world and placed safely in your arms. And I honestly think that no matter how it happens, where it happens or when it happens, you probably always wish you could have changed something. I wish I hadnt panicked so much when I went into labor. I wish Id taken the time to shower and look decent considering I despise the photos of me from that day. I wish Aaron and I had more alone time together during labor. And I wish that epidurals could be placed before the contractions begin ...
இப்பக்கம் கடைசியாக 25 ஏப்ரல் 2017, 04:22 மணிக்குத் திருத்தப்பட்டது ...
Caudal epidural analgesia was achieved in 6 adult horses on 3 successive occasions at weekly intervals by injection of lidocaine, xylazine, and a combination of lidocaine/xylazine through indwelling epidural catheters. Analgesia was defined as a lack of response to pinprick and hemostat pressure in the skin of the perineal area. A significant (P , 0.05) difference was not found for time of onset of analgesia between lidocaine (4.3 +/- 0.8 minutes, mean +/- SEM) and the lidocaine/xylazine combination (5.3 +/- 1.3 minutes). Time to onset of analgesia after administration of xylazine was significantly (P , 0.05) longer (32.0 +/- 3.4 minutes) than that for either of the other 2 treatments. Duration of analgesia was significantly (P , 0.05) longer for the combination (329.8 +/- 6.2 minutes) than for either drug used alone (lidocaine, 87.2 +/- 7.5 minutes; xylazine, 204.2 +/- 12.9 minutes). Pulse and respiratory rates were not significantly altered by any of the drugs. Neurologic sequelae were not ...
Epidural analgesia is regarded as the gold method for controlling post-thoracotomy pain. Intercostal nerve cryoanalgesia can also produce satisfactory analgesic effects, but is suspected to increase the incidence of chronic pain. However, randomized controlled trials comparing these two methods for post-thoracotomy acute pain analgesic effects and chronic pain incidents have not been conducted previously. We studied 107 adult patients, allocated randomly to thoracic epidural bupivacaine and morphine or intercostal nerve cryoanalgesia. Acute pain scores and opioid-related side effects were evaluated for three postoperative days. Chronic pain information, including the incidence, severity, and allodynia-like pain, was acquired on the first, third, sixth and twelfth months postoperatively. There was no significant difference on numeral rating scales (NRS) at rest or on motion between the two groups during the three postoperative days. The patient satisfaction results were also similar between the ...
Rebecca Benfield has conducted psychophysiological research with spontaneously laboring women at term gestation. Interest areas have included the effects of anxiety and pain interventions (hydrotherapy and epidural analgesia) on uterine contractility, labor progress and stress related neurohormones. Physiological instruments included: external uterine electromyography (EMG), intrauterine pressure catheter (IUPC), assays of plasma cortisol, epinephrine, norepinephrine, beta-endorphin, oxytocin, vasopressin, and urinary catecholamines and creatinine. Subjective measures of anxiety and pain included: visual analogue scales.. Presently Benfield is completing a retrospective study comparing labor contraction parameters measured by an intrauterine pressure catheter in women before and after a pre-epidural intravascular bolus and epidural analgesia. She has proposed a prospective pilot to measure EMG contractile bursts using this same design.. Benfield was funded by NINR for a K01 Mentored Independent ...
BACKGROUND: Clonidine is an alpha(2) adrenoreceptor and imidazoline receptor agonist, which has analgesic, sedative, and minimum alveolar anesthetic concentration-sparing effects. It has been used orally, IV, and epidurally. In spinal surgery, there is a reluctance to use local anesthetic-based epidural analgesia postoperatively because of fears of masking important signs of nerve root or spinal cord injury. METHODS: We randomized 66 patients undergoing uncomplicated decompressive spinal surgery to receive an epidural infusion of either clonidine (Group C) or saline placebo (Group P) postoperatively. Morphine consumption by patient-controlled analgesia device was recorded for 36 h. RESULTS: Morphine consumption was significantly lower in Group C. The mean consumption at 36 h was 35 mg (95% confidence interval 21-50 mg) in Group C, compared with 61 mg (95% confidence interval 48-74 mg) in the control group. Nausea was significantly reduced in Group C (6.5%), when compared with placebo (38.2%). CONCLUSION
TY - JOUR. T1 - Continuous epidural or intercostal analgesia following thoracotomy. T2 - A prospective randomized double-blind clinical trial. AU - Debreceni, Gábor. AU - Molnár, Z.. AU - Szélig, L.. AU - Molnár, T. F.. PY - 2003/10. Y1 - 2003/10. N2 - Background: Pain following thoracotomy is frequently associated with clinically important abnormalities of pulmonary function. The aim of the current study was to compare the efficacy of continuous thoracic epidural analgesia (EDA) to continuous intercostal (IC) block for postoperative pain and pulmonary function in a prospective, randomized, double-blinded clinical trial. Methods: Fifty patients undergoing lung lobectomy for malignancies were randomized into two groups (25/group). Respiratory function (forced vital capacity, forced expiratory volume per 1 s/forced vital capacity, maximum midexpiratory flow rate, peak expiratory flow rate) were evaluated preoperatively, within 4 h after the operation and on the first postoperative day. Visual ...
Epidural administration (from Ancient Greek ἐπί, "on, upon" + dura mater) is a medical route of administration in which a drug or contrast agent is injected into the epidural space of the spinal cord. Techniques such as epidural analgesia and epidural anaesthesia employ this route of administration. The epidural route is frequently employed by certain physicians and nurse anaesthetists to administer diagnostic (e.g. radiocontrast agents) and therapeutic (e.g., glucocorticoids) chemical substances, as well as certain analgesic and local anaesthetic agents. Epidural techniques frequently involve injection of drugs through a catheter placed into the epidural space. The injection can result in a loss of sensation-including the sensation of pain-by blocking the transmission of signals through nerve fibres in or near the spinal cord. The technique of "single-shot" lumbar epidural anaesthesia was first developed in 1921 by Spanish military surgeon Fidel Pagés (1886-1923). Spinal anaesthesia is a ...
Patient-Controlled Analgesia Pumps Patient-controlled analgesia (PCA) is a type of pain management that lets you decide when you will get a dose of pain medicine. In some situations, PCA may be a better way of providing pain relief than calling for someone (typically a nurse) to give you pain medicine. With PCA you dont need to wait for a nurse. And you can get smaller doses of pain medicine more often. With this type of pain treatment, a needle attached to an IV (intravenous) line is placed into 1 of ...
The following sub section has been added:. Epidural Analgesia There have been postmarketing reports of cauda equina syndrome and events indicative of neurotoxicity (see Section 4.8) temporally associated with the use of levobupivacaine for 24 hours or more for epidural analgesia. These events were more severe and in some cases led to permanent sequelae when levobupivacaine was administered for more than 24 hours. Therefore, infusion of levobupivacaine for a period exceeding 24 hours should be considered carefully and only be used when benefit to the patient outweighs the risk.. It is essential that aspiration for blood or cerebrospinal fluid (where applicable) be done prior to injecting any local anesthetic, both before the original dose and all subsequent doses, to avoid intravascular or intrathecal injection. However, a negative aspiration does not ensure against intravascular or intrathecal injection. Levobupivacaine should be used with caution in patients receiving other local anaesthetics ...
We conducted a retrospective study to determine whether bupivacaine or fentanyl is a better adjuvant to epidural morphine for postoperative analgesia using 108 patients. Following epidural lidocaine...
The clinical effects of multi-modal analgesia on postoperative pain and nosocomial infection in patients with lower limb fracture, Hong-Bo Li, Shou-Hui Xu
Spencer Liu is well known for his work on postoperative analgesia. Here he presents a systemic review of the evidence of analgesia and its effect on on postoperative complications such as respiratory and cardiac events. While they are cautious in their conclusions, an associated editorial by Paul White and Henrik Kehlet is critical of the methodology in most studies and highlights the way for future studies.. ...
A study comparing thoracic epidural bupivacaine with and without opioid to a continuous paravertebral infusion of bupivacaine showed that analgesia on all postoperative days was superior in the thoracic epidural group receiving bupivacaine plus hydromorphone, but was similar in the epidural and continuous paravertebral groups receiving bupivacaine alone (Grider et al. 2012, n=75, LoE 1 ...
Pain management information for pain medicine healthcare professionals in treating and caring for their patients. Clinical Pain Advisor offers news, case studies and more.
... an epidural needle is simply a needle that is placed into the epidural space. To provide continuous epidural analgesia or ... Frölich, MA; Caton, D (July 2001). "Pioneers in epidural needle design". Anesthesia and Analgesia. 93 (1): 215-20. doi:10.1097/ ... Frölich, MA; Caton, D (July 2001). "Pioneers in epidural needle design". Anesthesia and Analgesia. 93 (1): 215-20. doi:10.1097/ ... a small hollow catheter may be threaded through the epidural needle into the epidural space, and left there while the needle is ...
Ferrante FM, Lu L, Jamison SB, Datta S (1991). "Patient-controlled epidural analgesia: demand dosing". Anesth. Analg. 73 (5): ... This is similar to epidural infusions used in labour and postoperatively. The major differences are that it is much more common ... Caraceni, A; Zecca, E; Martini, C; De Conno, F (June 1999). "Gabapentin as an adjuvant to opioid analgesia for neuropathic ... Although opioids are strong analgesics, they do not provide complete analgesia regardless of whether the pain is acute or ...
A possible complication of epidural analgesia. British Medical Journal 285: 972 only. Brockington I F (2006) Eileithyia's ... Epidural anaesthesia can, if the dura is punctured, lead to leakage of Cerebrospinal fluid and subdural haematoma. All these ...
In epidural anesthesia or intrathecal analgesia. *For palliative care (i.e. to lessen pain without curing the underlying reason ...
Doughty, Andrew (1980). Epidural Analgesia in Obstetrics: A Second Symposium, University of Warwick, Coventry. London: Lloyd- ... Doughty, Andrew (1969). "Selective epidural analgesia and the forceps rate". British Journal of Anaesthesia. 41 (12): 1058-1062 ... He was an early promoter of the use of epidural anaesthesia during childbirth. In 1973, he set up an epidural course at ...
... is a form of analgesia, or pain relief, that uses electricity to ease pain. Electrical devices can be internal ... Chronic stimulation via percutaneously inserted epidural electrodes. Neurosurgery 1977;1: 215-8.]. [Han JS, Chen XH, Sun SL, et ... This electroanalgesic modality was originally recommended as an alternative to TENS for dental analgesia. In a 1999 randomized ... The term PNT was chosen because it more accurately describes the neurophysiologic basis for PENS-induced analgesia. ...
It is a method for the identification of the epidural space, a potential space. As a needle is advanced through the ligamentum ... Analgesia. 12 (2): 59-65. doi:10.1213/00000539-193301000-00014. Iklé A (July 1950). "Preliminary report of new technique for ... Wilson MJA (2007). "Epidural endeavour and the pressure principle". Anaesthesia. 62 (4): 319-324. doi:10.1111/j.1365-2044.2007. ... Epidural procedure History of neuraxial anesthesia Odom's indicator Dogliotti, AM (1933). "Research and clinical observations ...
Ferrante FM, Lu L, Jamison SB, Datta S (1991). "Patient-controlled epidural analgesia: demand dosing". Anesth. Analg. 73 (5): ... The World Health Organization (WHO) recommends a pain ladder for managing analgesia. It was first described for use in cancer ... This is similar to epidural infusions used in labour and postoperatively. The major differences are that it is much more common ... Caraceni, A; Zecca, E; Martini, C; De Conno, F (June 1999). "Gabapentin as an adjuvant to opioid analgesia for neuropathic ...
Medicine administered via epidural can cross the placenta and enter the bloodstream of the fetus. Epidural analgesia has no ... "Epidural versus non-epidural or no analgesia in labour". Cochrane Database of Systematic Reviews. CD000331 (12): CD000331. doi: ... Epidural analgesia is a generally safe and effective method of relieving pain in labour, but is associated with longer labour, ... Thorp, J.A.; Breedlove, G. (1996). "Epidural analgesia in labor: An evaluation of risks and benefits". Birth. 23 (2): 63-83. ...
As such, it has been used for analgesia in labor successfully; however, it is not as effective as epidural analgesia. In ... and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in ... Anesthesia & Analgesia, 110(2), 524-525. Feldman, P. L. (2006). Discovery and Development of the Ultrashort-acting Analgesic ... Hence, it causes a reduction in sympathetic nervous system tone, respiratory depression and analgesia. The drug's effects ...
... ropivacaine versus bupivacaine for epidural labor analgesia". Anaesthesia and Analgesia. 111 (2): 482-7. doi:10.1213/ANE. ... Analgesia. 108 (3): 997-1007. doi:10.1213/ane.0b013e31819385e1. PMID 19224816. Nouette-Gaulain K, Dadure C, Morau D, Pertuiset ... "Comparison of neosaxitoxin versus bupivacaine via port infiltration for postoperative analgesia following laparoscopic ...
"Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a ... chapter= ignored (help) Keech, Brian M. (2015). "Thoracic epidural analgesia in a child with multiple traumatic rib fractures ...
January 2004). "Epidural analgesia for acute symphysis pubis dysfunction in the second trimester". International Journal of ...
Neuraxial (regional) anesthetic and analgesia techniques: (e.g. epidural, spinal, combined spinal-epidural) are used most ... Charles B. Odom introduced lumbar epidural analgesia to obstetrics in 1935. The anesthesiologist relies on several patient ... the lumbar epidural approach in 1921. In 1921, the first vaginal delivery under spinal analgesia was reported by Kreiss in ... Labor analgesia was debated on the grounds of religion and morality, which John Simpson used as his own weapon against ...
Epidural tezampanel, an AMPA/kainate receptor antagonist, produces postoperative analgesia in rats. Anesthesia and Analgesia. ...
... "epidural steroid injection". Although this technique began more than a decade ago for FBSS, the efficacy of epidural steroid ... Wang JK (January 1976). "Stimulation-produced analgesia". Mayo Clin. Proc. 51 (1): 28-30. PMID 765636. de la Porte C, Siegfried ... Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti- ... Epidural scarring caused by the initial pathology or occurring after the surgery can also contribute to nerve damage. In one ...
"Usefulness of the Tsui Test in Combined Spinal-Epidural Analgesia in Labour". ClinicalTrials.gov. ClinicalTrials.gov. Retrieved ... "Catheter Set for Epidural or Peripheral Nerve Blockade". Justia Patents. Retrieved 6 October 2014. "StimuLong Sono-Tsui Set" ( ... The Tsui Test is a simple protocol using a low current electrical stimulation test to confirm catheter location in the epidural ... Examples include describing the Tsui Test and developing the StimuLong Sono-Tsui for ease of pediatric epidural placement. ...
... (also known as audio-analgesia) is the relief of pain using white noise or music without using pharmacological ... This measure is similar to breathing exercises during cramps before administration of epidurals. It has also been suggested ... Anesthesia Gardner, WJ; Licklider JC (1959). "Auditory analgesia in dental operations". J Am Dent Assoc. 59: 1144-1149. PMID ... "Audio analgesia revisited". Anesthesia Progress. 16 (1): 8-14. PMC 2235527 . PMID 5250548. "Nonpharmacologic Approaches to ...
Thoracic epidural analgesia or paravertebral blockade have shown to be the most effective methods for post-thoracotomy pain ... Treatment to aid pain relief for this condition includes intra-thoracic nerve blocks/opiates and epidurals, although results ... Assessing the effects of transcutaneous electrical nerve stimulation (TENS) in post-thoracotomy analgesia. Rev Bras Anestesiol ... "Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in ...
An Efficient Alternative to Counteract Hypotension During Combined General/Epidural Anesthesia". Anesthesia & Analgesia. 90 (6 ...
Medical management of pain is rarely found in home births, but analgesia (i.e. epidural) is prevalent in the hospitals. Touch, ...
... occurrence of prolonged postoperative mechanical ventilation and myocardial infarction is also reduced by epidural analgesia. ... "Patient controlled opioid analgesia versus conventional opioid analgesia for controlling postoperative pain". Cochrane Database ... It may include analgesia (relief from or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), or ... Examples include epidural anaesthesia and spinal anaesthesia. In preparing for a medical procedure, the health care provider ...
... is indicated for local anaesthesia including infiltration, nerve block, ophthalmic, epidural and intrathecal ... anaesthesia in adults; and infiltration analgesia in children. Levobupivacaine is contraindicated for IV regional anaesthesia ( ...
... (pKa 8.7) is the drug of choice for epidural analgesia and a decompensating fetus, because it does not ... Fetal acidosis, 2-chloroprocaine, and epidural anesthesia for cesarean section. Am J Obstet Gynecol. 1985 Feb 1;151(3):322-4. ... several cases were reported of neurological deficits after inadvertent intrathecal injections intended for epidural delivery.[4 ...
The long duration and high lipophilicity of lofentanil has been suggested as an advantage for certain types of analgesia, but ... 258 (1): 171-3. Meert, TF; Lu, HR; van Craenndonck, H; Janssen, PA (Sep 1988). "Comparison between epidural fentanyl, ... sufentanil, carfentanil, lofentanil and alfentanil in the rat: analgesia and other in vivo effects". European Journal of ...
... begins with the contraction of the muscles attached to the rib cage; this causes an expansion in the chest cavity. Then takes place the onset of contraction of the diaphragm, which results in expansion of the intrapleural space and an increase in negative pressure according to Boyle's law. This negative pressure generates airflow because of the pressure difference between the atmosphere and alveolus. Air enters, inflating the lung through either the nose or the mouth into the pharynx (throat) and trachea before entering the alveoli.[citation needed] Other muscles that can be involved in inhalation include:[2] ...
The available data clearly indicates that epidural analgesia with a local anesthetic-based regimen provides superior analgesia ... The use of perioperative epidural anesthesia-analgesia provides superior postoperative analgesia [1-3] versus conventional ... The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, ... patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and ...
OA, Leon-Casasola (October 1996). "Postoperative epidural analgesia: What are the choices?". Anaesthetic Analgesia. 63 (4): 863 ... Epidural opioid analgesia is a technique to reduce pain from labour. Opioids act by interacting with specific receptors in the ... Epidural opioids can produce analgesia without motor or sympathetic blockade. Lipid soluble opioids stay in the cerebrospinal ... However, in this case, the onset of analgesia is delayed. The lipophilicity of an opioid is determined by its octanol-buffer ...
Epidural is of course the best form of labour analgesia. Aim is to find out an alternative method of labour analgesia where ... epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis. González ... Use of epidural analgesia in post-operative pain management. Weetman, Caroline; Allison, Wendy // Nursing Standard;7/12/2006, ... Patient-controlled epidural analgesia is superior to nitrous oxide inhalation in controlling childbirth pain. Xiaoming Feng; ...
Epidural analgesia. What is epidural analgesia?. Analgesia means pain relief. The word epidural refers to a place in the back ... Compared to other methods of pain control, less pain medicine is usually needed when epidural analgesia has been used. Good ... Studies have shown that epidural analgesia provides excellent pain control for children. ... Children are usually on the epidural medicine for 2 to 5 days. Your nurses and anesthesiologist will talk to you and your child ...
Researchers have shown that epidural analgesia administered in the early stage of labor compared to later use does not increase ... epidural analgesia provides better pain relief than systemic analgesia and is also more effective than systemic analgesia in ... The researchers compared the group of women who had received epidural analgesia early in labor with the group of women who ... Women in the other group received systemic hydromorphone at the first request for pain relief and epidural analgesia at either ...
Periosteal Entrapment of an Epidural Catheter in the Intrathecal Space * The Effects of the Reverse Trendelenburg Position on ... Home , December 1992 - Volume 75 - Issue 6 , Removal of a Tenacious Epidural Catheter ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ...
Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing. ... Diseases : Analgesia, Cesarean Section. Anti Therapeutic Actions : Cesarean Delivery, Epidural Analgesia, Obstetric ... Labor involving epidural analgesia is associated with a 2-fold increase in reports of partial breast feeding or formula feeding ... 7 Abstracts with Epidural Analgesia Research. Filter by Study Type. Human Study. ...
Epidural Injections of Autologous Blood for Postlumbar-Puncture Headache Anesthesia & Analgesia49(2):268-271, March-April 1970 ... Epidural Injection of Autologous Blood For Postlumbar-Puncture Headache: II. Additional Clinical Experiences and Laboratory ... Finding Cerebrospinal Fluid during Epidural Blood Patch: How to Proceed * Spinal Subdural Epiarachnoid Hematoma: A Complication ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ...
Labor analgesia: Comparison of epidural patient-controlled analgesia and intravenous patient-controlled analgesia].. [Article ... However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated ... In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) ... In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and ...
Home , November 1992 - Volume 75 - Issue 5 , Epidural Hematoma: Was Catheter Removed During Complete An t... ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ... Thought you might appreciate this item(s) I saw at Anesthesia & Analgesia.. ...
Few studies evaluated epidural analgesia in induced labors. ... epidurals offered better pain relief, but were associated with ... Compared with other types of analgesia or no analgesia, ... Epidural versus non-epidural or no analgesia in labour Cochrane ... all but five studies compared epidural analgesia with opiates. Epidural analgesia was found to offer better pain relief (mean ... singleton vaginal deliveries occur with epidural or spinal analgesia.3 Few dispute that epidural analgesia provides good pain ...
Procedure: Analgesia without doula Epidural analgesia in the latent phase of first stage of labor without doula accompany in ... Procedure: Doula combined analgesia Doula combined epidural analgesia in the latent phase of first stage of labor in primiparas ... Doula Combined Latent Phrase Epidural Analgesia in Primiparous Women (DCLEAP). The safety and scientific validity of this study ... Epidural analgesia in the latent phase of the first stage of labor without doula accompany ...
Active Comparator: single epidural catheter Drug: epidural catheter epidural catheter with 0.3% ropivacaine ... Active Comparator: double epidural catheter Drug: epidural catheter epidural catheter with 0.3% ropivacaine ... Single vs Double Epidural Catheter Analgesia for Scoliosis Surgery. The safety and scientific validity of this study is the ... This is a study comparing pain control utlilizing one or two epidural catheters, along with a hydromorphone PCA, for analgesia ...
It is differentiated from ANESTHESIA, EPIDURAL which refers to the state of insensitivity to sensation. ... The relief of pain without loss of consciousness through the introduction of an analgesic agent into the epidural space of the ... Epidural Analgesia. Subscribe to New Research on Epidural Analgesia The relief of pain without loss of consciousness through ... epidural analgesia provides safe and effective labor pain control.". 03/01/2008 - "Epidural analgesia (EA) is an effective and ...
Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty?. Horlocker TT1, ... Postoperative epidural analgesia was used in 108 cases and was not a significant risk factor for the development of peroneal ... Since diagnosis of peroneal nerve palsy may be delayed in patients with postoperative epidural analgesia, these patients must ... occurred in patients receiving postoperative epidural analgesia and were diagnosed after discontinuation of the epidural ...
We conducted a retrospective study to determine whether bupivacaine or fentanyl is a better adjuvant to epidural morphine for ... epidural morphine bupivacaine fentanyl post-operative analgesia This is a preview of subscription content, log in to check ... 1991) Combination of epidural morphine and fentanyl for postoperative analgesia. Reg Anesth 16:214-217PubMedGoogle Scholar ... 1989) Effect of diluent on analgesia produced by epidural fentanyl. Anesth Analg 68:808-810PubMedCrossRefGoogle Scholar ...
Beliefs about epidural [ Time Frame: antepartum ]. Inventarisation of the beliefs about epidural analgesia ... The Randomised Epidural Analgesia in Term Delivering Women Trial (TREAT) (TREAT). The safety and scientific validity of this ... Active Comparator: Epidural analgesia Women will be allocated to the EA group. In the EA group, women are given an EA as soon ... If necessary epidural analgesia.. Other: Care-as usual pain treatment Pain treatment only on request of the women in labour. ...
To compare efficacy of tramadol injection as an opioid analgesia versus epidural analgesia on governing labor pain, progress ... Group B (epidural group) received Epidural - 0.125% bupivacaine with fentanyl 5 mcg. Epidural analgesia is adjusted to least ... Aim of the study: To compare efficacy of tramadol injection as an opioid analgesia versus epidural analgesia on governing labor ... epidural catheter was fixed with adhesive plaster at back. Epidural analgesia is adjusted to least analgesic dose (10-15 ml/hr ...
... clinicaltrials.gov The objectives of this study will be to compare epidural infusion management, specifically looking at ... Patients who require a decrease in their basal labor analgesia epidural infusion rate will have an increased incidence of ... The database will be queried for the following; maternal age, parity, gestational age, type of analgesia, changes in epidural ... Home » Topics » Anesthesiology » Research » The Association Between Decreasing Labor Analgesia Epidural Infusion and Forceps ...
In patients without epidural analgesia, 7.4% had OVD, versus 9.5% of patients with epidural analgesia (Table 3). χ2 testing did ... Epidural analgesia and severe perineal laceration in a community-based obstetric practice. J Am Board Fam Pract 2003;16:1-6. ... Epidural Analgesia and Any Vaginal Laceration Message Subject (Your Name) has sent you a message from American Board of Family ... Epidural analgesia and severe perineal tears: A literature review and large cohort study. J Matern Fetal Neonatal Med 2014;27: ...
Can Women in Labor Give Informed Consent to Epidural Analgesia?. This is a Wiley-Blackwell Publishing paper. Wiley-Blackwell ... Can Women in Labor Give Informed Consent to Epidural Analgesia?. Bioethics, Vol. 33, Issue 4, pp. 475-486, 2019 ... Wada, Kyoko and Charland, Louis and Bellingham, Geoff, Can Women in Labor Give Informed Consent to Epidural Analgesia? (May ... Keywords: decision‐making capacity, epidural analgesia, feminism, informed consent, labor pain, mental competence ...
Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural ... technique and maintained with a continuous epidural infusion with patient controlled epidural analgesia boluses ... technique and maintained with a continuous epidural infusion with patient controlled epidural analgesia boluses ... The Association Between Decreasing Labor Analgesia Epidural Infusion and Forceps Delivery. The safety and scientific validity ...
Device: patient controlled epidural analgesia epidural catheter, epidural loading dose of 1 ml/10 kg of 0.15% bupivacaine with ... NSAIDs With Morphine-PCA Compared to Epidural Analgesia in Thoracotomy Pain. The safety and scientific validity of this study ... intravenous patient-controlled analgesia with morphine is an efficacious alternative to thoracic epidural analgesia. ... Re-thoracotomy, and the patient´s inability to understand the use of PCA/patient controlled thoracic epidural analgesia (PCEA). ...
Epidural Analgesia (EDA) Versus Patient Controlled Analgesia (PCA) in Laparoscopic Colon Surgery (EVA). The safety and ... Epidural Analgesia (EDA) Versus Patient Controlled Analgesia (PCA) in Laparoscopic Colon Surgery: A Monocentric Controlled Non- ... The purpose of this study is to determine whether a epidural analgesia versus patient controlled analgesia reduces the medical ... Epidural Analgesia (EDA) Versus Patient Controlled Analgesia (PCA) in Laparoscopic Colon Surgery. ...
those who will receive thoracic epidural analgesia for 6 days. *those who will receive thoracic epidural analgesia for 3 days ... Thoracic Epidural Analgesia Sympathetic Outflow Atrial Fibrillation Other: Thoracic Epidural Analgesia (TEA) Other: TEA ... Other: Thoracic Epidural Analgesia (TEA) Active Comparator: 3 days TEA and 3 days intravenous morphine Postoperative analgesia ... Effect of Thoracic Epidural Analgesia for Thoracotomy on the Occurrence of AF. The recruitment status of this study is unknown ...
  • The identification of this space, allows subsequent administration of epidural anaesthesia, a technique used primarily for analgesia during childbirth. (wikipedia.org)
  • In our initial analysis [ 6 ], we examined several surgical procedures (based on International Statistical Classification of Diseases, Ninth Revision (ICD-9) codes) and divided patients into 2 groups, depending on the presence or absence of postoperative epidural analgesia. (hindawi.com)
  • Subsequent analyses of the Medicare claims data also revealed that the presence of postoperative epidural analgesia may be associated with lower perioperative mortality in patients undergoing higher-risk surgical procedures (e.g., lung lobectomy, colectomy) [ 7 , 8 ]. (hindawi.com)
  • Epidural analgesia is a routine procedure in cattle, used in various surgical procedures e.g. cesarean section, foreign body removement etc. (vetcontact.com)
  • Epidural Anesthesia and Analgesia in High-risk Surgical Patients. (asahq.org)
  • Epidural analgesia or anesthesia attenuates the surgical stress response and prevents the inhibition of the immune system. (asahq.org)
  • We hypothesized that when corrected for other covariates that represent known risk for cancer recurrence ( e.g. , hypothermia and blood transfusion), 11,12 epidural analgesia/anesthesia would decrease the recurrence rate in patients with colorectal cancer presenting for surgical resection. (asahq.org)
  • Evidence that use of epidural analgesia also enhances the recovery process would lead to wider adoption of this method and better quality of care for surgical patients. (asahq.org)
  • Urgent CT/MRI to confirm the diagnosis followed by urgent surgical decompression to avoid permanent neurological damage Epidural abscess, again with potential permanent neurological damage. (wikipedia.org)
  • In general, neuromodulation systems deliver electrical currents and typically consist of the following components: An epidural, subdural or parenchymal electrode placed via minimally invasive needle techniques (so-called percutaneous leads) or an open surgical exposure to the target (surgical "paddle" or "grid" electrodes), or stereotactic implants for the central nervous system, and an implanted pulse generator (IPG). (wikipedia.org)