Combined spinal-epidural for labor analgesia with low-dose bupi- vacaine but without any opioid in the spinal component: can we improve upon the traditional?

AIM: To compare the efficacy and safety of combined spinal-epidural (CSE, with the spinal component using low-dose heavy bupivacaine without opioid) with low-dose epidural analgesia in labor. METHODS: Sixty consenting adult parturients requesting epidural were randomly allocated to two equal groups to receive either low-dose epidural or CSE analgesia. The Epidural Group received 10ml of a mixture of 0.1% bupivacaine and 2 µg/ml fentanyl, followed by a 6 ml first bolus after 10 min if needed (not considered as a top-up). All patients received 8 ml/h continuous background infusion, with patient-controlled top-up bolus of 6 ml with a lock-out interval of 12 min. In the CSE Group, 0.5% (heavy) bupivacaine 2.5 mg was used to produce spinal block (without concomitant use of any opioid), followed by epidural continuous background infusion of 8 ml of 0.1% of bupivacaine and 2 µg/ml of fentanyl, with a similar top-up provision as in the Epidural Group. Primary outcome was total drug consumption during labor, corrected by the duration of labor (ml/h). RESULTS: Mean total drug consumption during labor was significantly less in the CSE group (9.69 ml/h) than in Epidural group (13.52 ml/h ; P < 0.00 1). CSE also led to significantly faster onset of analgesia and sensory block. There was no significant difference between the two groups with regard to all other variables. Maternal satisfaction was rated as 'excellent' by all subjects. CONCLUSIONS: CSE using low-dose heavy bupivacaine without opioid required less drug consumption produced faster onset of pain control and sensory block than low-dose epidural analgesia. There were no other significant inter-group differences.

Contraceptive practices and awareness of emergency contraception in educated working women.

BACKGROUND: Regular contraceptive use and emergency contraception are tools to prevent pregnancies. AIMS: This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital. SETTINGS: Educated workingwomen in a medical college hospital. DESIGN: Cross-sectional study. MATERIALS AND METHODS: The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception. RESULTS: Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception. CONCLUSIONS: A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.