The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery: A Double-Blind Prospective Randomized Control Trial.

BACKGROUND: Spinal anesthesia has become the most common type of anesthetic for cesarean delivery. The major limitation to spinal anesthesia is that the duration of the anesthetic may not be adequate in the event of a prolonged surgery. Some practitioners add epinephrine to hyperbaric bupivacaine to increase the duration, although its effect has not been fully studied. We therefore aimed to evaluate whether adding epinephrine to the spinal medication prolongs the duration of action of the resultant block in women presenting for repeat cesarean delivery. METHODS: Sixty-eight patients were randomized to receive no epinephrine (NE group), epinephrine 100 µg (low-dose [LD] group), or epinephrine 200 µg (high-dose [HD] group) with a standardized spinal mixture (1.5 mL 0.75% hyperbaric bupivacaine with 0.25 mg morphine). Sixty-five patients were included for primary analysis. Our primary outcome was time to intraoperative activation of the epidural catheter or postoperative regression of sensory blockade to T-10 dermatome level as measured by pinprick sensation; motor recovery was a secondary outcome, and graded via a Modified Bromage scale. RESULTS: Block onset time, vital sign changes, and the incidence of hypotension; nausea, and vomiting were similar among groups. Median difference in time to T-10 regression was greatest in the HD group compared to the NE group (median difference [min] [95% confidence interval]: 40 [15-60]; P = .007), followed by the HD group to the LD group (30 [15-45]; P = .007). Comparisons of LD to NE were not significant, but trended to an increase in T-10 regression time (10 [-15 to 30]; P = .76). Median difference in time to knee extension (Bromage 3) was also greatest in the HD group when compared to both the LD and NE group (median difference [min] [95% confidence interval]: 30 [0-60]; P = .034, 60 [0-93]; P = .007). Median difference time to knee extension (min) between the LD and NE group was also significant (37.5 [15-60]; P = .001]. Pain scores during the procedure were higher in the NE group (median [interquartile range] HD: 0 [0-0], LD: 0 [0-0], NE: 0 [0-3]; P = .02) during uterine closure and were otherwise not significantly different from the other groups. CONCLUSIONS: In this single center, prospective, double-blind, randomized control trial, the addition of epinephrine 200 µg to hyperbaric bupivacaine and preservative-free morphine for repeat cesarean delivery prolonged the duration of the sensory blockade. Motor blockade was similarly prolonged and block quality may have been enhanced.

Análise do nascimento Bororo: aspectos culturaisda dor de parto / Analysis Bororo birth: cultural aspects of labor pain

Considerando que as formas de sentir e expressar a dor são regidas por códigos culturais e tal sentimento se constituia partir de significados conferidos pela coletividade, esse estudo etnográfico buscou compreender os sentidos esignificados da dor de parto para mulheres indígenas da etnia Bororo. Pesquisa desenvolvida no primeiro semestre de2015, em Córrego Grande, aldeia localizada no município de Santo Antônio do Leverger/MT, por meio da observaçãoparticipante, entrevistas e estudos bibliográficos adotando-se como referencial teórico a Antropologia da Saúde. Amanifestação da dor de parto ou sua ausência, como no caso das mulheres Bororo, está intimamente relacionadaao aprendizado sociocultural que se inicia ainda na infância. O parto apresentou-se como momento oportuno paraque as mulheres Bororo reafirmassem a força que possuem demonstrada no silêncio e resignação durante todo otrabalho de parto, diferentemente da sociedade brasileira no seculo XXI, em que a dor possui caráter trágico e temsido cada vez mais combatida com analgésicos e anestésicos. A população Bororo compreendem essa dor comoprocesso natural que deve ser conduzido sem interferências ou medicação alopática. Conclui-se que é importantepara os profissionais da saúde tentar compreender os aspectos socioculturais envolvidos na dor de parto para além dacompreensão biomédica, oportunizando cuidado diferenciado de acordo com as necessidades e especificidades dasmulheres e famílias atendidas.

Whereas the ways to feel and express pain are governed by cultural codes and this feeling is from meanings conferredby the community, this ethnographic study aimed to understand the meanings of labor pain for indigenous women ofthe Bororo ethnic. Research conducted in the first half of 2015 in Great Stream, the village located in Santo Antonioof Leverger city/MT, through participant observation, interviews and bibliographical studies adopting as theoreticalframework the Anthropology of Health. The manifestation of labor pain or lack thereof, as in the case of the Bororowomen, is closely related to socio-cultural learning that begins in childhood. Childbirth was presented as the appropriatetime for the Bororo women reaffirm the strength that have demonstrated in silence and resignation throughoutlabor and delivery, brazilian society of the XXI century in which pain has tragic character and has been increasinglycombated with analgesics and anesthetics. Bororo’s population understand this pain as a natural process that shouldbe conducted without interference or allopathic medication.. It concludes that it is important for health professionals totry to understand the social and cultural aspects involved in the delivery of pain beyond the biomedical understanding,providing opportunities for differentiated care according to the needs and characteristics of women and families served.

The location of needle insertion effect on maternal pain in amniocentesis.

OBJECTIVE: The purpose of this study was to determine whether maternal pain in amniocentesis was associated with the location of needle insertion and other identifiable clinical correlates. MATERIAL AND METHOD: This prospective study of mid-trimester amniocentesis was conducted between October 2005 and December 2005. Women were asked to complete a visual analog scale (VAS) after the amniocentesis. The distance from uterine fundus to symphysis pubis and from the location of needle insertion to symphysis pubis were measured and calculated to divide the insertion into two groups: upper third and middle third. The effect of previous amniocentesis, previous abdominal surgery, needle insertion through placenta and operators' experience was determined. The t-test was used for analysis; a probability value of < 0.05 was considered significant. RESULTS: Seventy-two women were participated in the study. The mean VAS was 2.7 +/- 2.1. The perception of pain was significantly less in patients with the upper-third insertion as compared with the middle third insertion (VAS 2.2 vs 3.9, p = 0.002). Previous amniocentesis, previous abdominal surgery, needle insertion through placenta and operators' experience had no impact on pain intensity. CONCLUSION: The pain from amniocentesis was significantly less in the patients with the needle insertion in the upper third of the uterus.