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1.
Ann Afr Med ; 22(1): 88-93, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36695228

RESUMO

Objective: This study aims to compare levobupivacaine 0.125% and ropivacaine 0.2% with fentanyl as epidural drugs for labor analgesia using combined spinal epidural (CSE) technique regarding time for onset, duration of analgesia achieved by first epidural bolus dose and to compare the quality of labor analgesia. In addition, the study is also designed to assess the maternal and fetal outcome, incidence of instrumental delivery, degree of motor blockade, and maternal satisfaction. Materials and Methods: Following approval from Institutional Ethical Committee, 50 American Society of Anesthesiologists Physical Status II pregnant women requesting labor analgesia, satisfying the inclusion criteria were randomly divided equally into Groups L and R. CSE performed, 0.5 ml hyperbaric bupivacaine 0.5% with fentanyl 25 mcg administered intrathecally. IEBs 10 ml of study drugs given through epidural catheter as demand dose. Results: The mean onset of analgesia with Group R and group L were 16.280 ± 1.59 min and 21.480 ± 1.32 min(P = 0.000) respectively. The total duration of analgesia in Group R = 72.08 ± 1.97 min, whereas Group L = 82.160 ± 2.07 min (P = 0.000). There was no difference between the groups in terms of maternal demographic traits, mode of delivery, maternal and fetal outcome, and maternal satisfaction. Both 0.125% levobupivacaine and 0.2% ropivacaine produce excellent-quality of analgesia. Conclusion: Ropivacaine produces an early onset of analgesia than levobupivacaine but levobupivacaine had significantly prolonged analgesia compared to ropivacaine. Both drugs were found to be safe for labor analgesia. Maternal satisfaction and fetal outcome were similar with both the drugs.


Résumé Objectif: Cette étude vise à comparer la lévobupivacaïne 0,125% et la ropivacaïne 0,2% avec le fentanyl en tant que médicaments périduraux pour l'analgésie du travail .utilisant la technique épidurale rachidienne combinée (CSE) concernant le temps d'apparition, la durée de l'analgésie obtenue par la première dose de bol épidural et .pour comparer la qualité de l'analgésie du travail. En outre, l'étude est également conçue pour évaluer les résultats maternels et fœtaux, l'incidence de .accouchement instrumental, degré de blocage moteur et satisfaction maternelle. Matériaux et méthodes: Après approbation de l'établissement .Comité d'éthique, 50 American Society of Anesthesiologists Statut physique II femmes enceintes demandant une analgésie du travail, satisfaisant le .les critères d'inclusion ont été répartis au hasard de manière égale en groupes L et R. CSE réalisée, 0,5 ml de bupivacaïne hyperbare à 0,5% avec du fentanyl .25 mcg administrés par voie intrathécale. IEBs 10 ml de médicaments à l'étude administrés par cathéter péridural en dose à la demande. Résultats: L'apparition Moyenne. les taux d'analgésie avec le groupe R et le groupe L étaient de 16,280 ± 1,59 minutes et de 21,480 ± 1,32 minutes (P = 0,000). La durée totale de l'analgésie en . Groupe R = 72,08 ± 1,97 min, tandis que Groupe L = 82,160 ± 2,07 min (P = 0,000). Il n'y avait pas de différence entre les groupes en termes de .traits démographiques maternels, mode d'accouchement, résultats maternels et fœtaux et satisfaction maternelle. lévobupivacaïne à 0,125% et 0,2% .la ropivacaïne produit une excellente qualité d'analgésie. Conclusion: La ropivacaïne produit un début précoce d'analgésie que la lévobupivacaïne mais.la lévobupivacaïne avait une analgésie significativement prolongée par rapport à la ropivacaïne. Les deux médicaments se sont avérés sans danger pour l'analgésie du travail. Maternelle la satisfaction et les résultats fœtaux étaient similaires avec les deux médicaments. Mots-clés: Épidurale rachidienne combinée, analgésie du travail, lévobupivacaïne, ropivacaïne.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Feminino , Gravidez , Humanos , Ropivacaina , Levobupivacaína , Fentanila , Anestésicos Locais , Estudos Prospectivos , Amidas , Analgesia Epidural/métodos , Bupivacaína , Analgesia Obstétrica/métodos , Método Duplo-Cego
3.
Eur Rev Med Pharmacol Sci ; 27(1): 130-137, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36647860

RESUMO

OBJECTIVE: The aim of the study was to investigate the impact of epidural analgesia on the stages of labor and maternal and neonatal outcomes. PATIENTS AND METHODS: A retrospective cohort study was conducted in the First Affiliated Hospital of Guangxi Medical University from January 1, 2020 to September 30, 2020. A total of 472 parturient met the inclusion criteria. Of them, 246 parturients received labor analgesia and 226 did not (control group). Their general characteristics, the length of labor, adverse reactions to analgesia, and maternal and neonatal outcomes between the two groups were compared to analyze and evaluate the feasibility of epidural analgesia in labor. RESULTS: (1) The women in the analgesia group experienced a significantly longer (p<0.001) 1st stage, 2nd stage, and total stage during labor; (2) the usage rate of oxytocin, the rate of external cephalic version, and the success rate of external cephalic version were all significantly higher in the analgesia group (p<0.001); (3) there was no statistically significant difference between the vaginal delivery rate and transit cesarean section rate of the two groups; (4) compared with the control group, the incidence of intrapartum fever was significantly increased in the analgesia group (p<0.05); (5) there was no statistically significant difference between the two groups in postpartum hemorrhage, neonatal Apgar score, and neonatal asphyxia rate. CONCLUSIONS: (1) Labor analgesia may prolong the 1st and 2nd stages of labor and increases the incidence of intrapartum fever, without increasing the rate of transit to cesarean section and postpartum hemorrhage; (2) labor analgesia does not negatively affect the Apgar score or increase the neonatal asphyxia rate.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Hemorragia Pós-Parto , Recém-Nascido , Gravidez , Feminino , Humanos , Cesárea , Analgesia Epidural/efeitos adversos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Estudos Retrospectivos , Asfixia/etiologia , China/epidemiologia , Analgesia Obstétrica/efeitos adversos
4.
Bratisl Lek Listy ; 124(2): 116-120, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36598299

RESUMO

BACKGROUND: Differences in neonatal pharmacokinetics are known to cause systemic accumulation of levobupivacaine with adverse effects during epidural analgesia. Therefore, it is not recommended to surpass 48 hours of administration in neonates. Free and total levobupivacaine levels are considered as predictors of toxicity. OBJECTIVE: The aim of the LEVON pilot study was to detect the accumulation of levobupivacaine during epidural analgesia exceeding 48 hours in neonates. METHODS: Ten neonates received a loading dose of levobupivacaine (1.25 mg/kg) followed by a continuous infusion (0.2 mg/kg/hour) epidurally. Free and total levobupivacaine concentrations were measured 0.5, 1, 6, 12, 36, 72 and 144 hours after the start of infusion. Cumulative doses of levobupivacaine, pain scores and clinical signs of toxicity were used for assessing efficacy and safety. RESULTS: The median concentrations of total levobupivacaine were 586.0, 563.0, 837.5, 957.0, 1930.0, 708.5 and 357.5 ng/ml. The median concentrations of free levobupivacaine were 4.0, 3.6, 5.5, 3.6, 5.5, 0.8 and 0.0 ng/ml. Three patients reached concerning concentrations of total levobupivacaine. Levels of free levobupivacaine remained low. No signs of toxicity were observed. CONCLUSION: Caudal epidural analgesia with levobupivacaine lasting longer than 48 hours appears to be safe providing that free levobupivacaine levels are below the presumed threshold for toxicity (Tab. 1, Fig. 1, Ref. 29). Text in PDF www.elis.sk Keywords: free levobupivacaine, total levobupivacaine, neonate, caudal continuous epidural analgesia, postoperative pain.


Assuntos
Analgesia Epidural , Recém-Nascido , Humanos , Levobupivacaína , Analgesia Epidural/efeitos adversos , Anestésicos Locais/efeitos adversos , Anestésicos Locais/farmacocinética , Bupivacaína/efeitos adversos , Projetos Piloto , Medição da Dor , Método Duplo-Cego , Dor Pós-Operatória
5.
Reg Anesth Pain Med ; 48(1): 29-36, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36167478

RESUMO

INTRODUCTION: Regional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery. METHODS: A retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight. RESULTS: 158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34-51) for no regional to 64 min (IQR 40-97) for regional catheters (p<0.01). The regional catheter group had lower median intraoperative opioid usage (0.24 vs 0.80 mg/kg morphine equivalents, p<0.01) as well as lower in-hospital postoperative opioid usage (0.05 vs 0.23 mg/kg/day morphine equivalents, p<0.01). Pain scores were not higher in the regional catheters group. DISCUSSION: Continuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population. TRIAL REGISTRATION NUMBER: NCT03245242.


Assuntos
Analgesia Epidural , Disrafismo Espinal , Criança , Humanos , Analgésicos Opioides , Morfina , Estudos Multicêntricos como Assunto , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Disrafismo Espinal/diagnóstico , Disrafismo Espinal/cirurgia , Disrafismo Espinal/complicações
6.
Anesth Analg ; 136(1): 86-93, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534717

RESUMO

BACKGROUND: Previous studies have suggested that administration of epidural 3% 2-chloroprocaine (CP) before epidural morphine results in decreased analgesic efficacy of epidural morphine. We sought to determine whether these observations were a result of antagonism or a window period between the conclusion of surgical anesthesia for cesarean delivery and the peak onset time of epidural morphine, and whether a method to preserve the analgesic efficacy of epidural morphine exists. METHODS: Term parturients scheduled for nonemergent, unscheduled cesarean delivery with preexisting labor epidural catheters were recruited for this exploratory, randomized, single-blinded, noninferiority trial. Subjects were randomized to initial dosing to a T4 dermatome surgical anesthetic level with either 3% CP or 2% lidocaine with 1:200,000 epinephrine and sodium bicarbonate (LEB). Subsequent redosing for both groups was performed with LEB at regular intervals. Epidural morphine 3 mg was administered to both groups after delivery. Assessing the difference between the 2 groups in total opioid use for the first 24 hours after epidural morphine administration was the primary objective. The noninferiority margin of 10 oral milligram morphine equivalents was prespecified based on previous noninferiority studies. Secondary end points included time from epidural morphine administration to first rescue opioid request, numerical pain scores, nausea/vomiting, and pruritus. RESULTS: Data were analyzed for 40 parturients, 20 in each group. The median 24-hour opioid consumption for the CP group was 0 (Q1 = 0 and Q3 = 15.6) oral milligram morphine equivalents compared to 15 (6.3-22.5) for the LEB group. The median difference was -7.5, with a 95% confidence interval -15 to 0. Noninferiority was concluded, as the confidence interval was less than the predetermined noninferiority margin of 10 oral milligram morphine equivalents. There was no treatment effect on time to first opioid request and no statistically significant differences in pain scores or nausea, vomiting, or pruritus at all time points (4, 8, 12, and 24 hours after epidural morphine administration). CONCLUSION: While designed as an exploratory study, initial epidural dosing with 3% CP and beginning subsequent redosing with LEB within 30 minutes of the initial CP bolus provided noninferior postcesarean analgesia with epidural morphine compared to initial epidural dosing and redosing with LEB. Previous observations of decreased analgesic efficacy of epidural morphine after epidural CP were likely due to a window period that may be mitigated by redosing with lidocaine; however, larger studies are necessary to confirm these findings.


Assuntos
Analgesia Epidural , Morfina , Gravidez , Feminino , Humanos , Analgésicos Opioides , Analgesia Epidural/métodos , Dor Pós-Operatória , Náusea , Lidocaína , Prurido , Vômito , Método Duplo-Cego
7.
J Affect Disord ; 324: 502-510, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36586623

RESUMO

BACKGROUND: Postpartum depression (PPD) is a general depressive episode after childbirth. Studies have shown that unmatched analgesic intention increases the risk of PPD, but the use of labor epidural analgesia (LEA) during childbirth can reduce this risk. We aimed to investigate the association between maternal childbirth intention, LEA, and PPD and risk factors that may be related to PPD. METHODS: A total of 590 mothers were included in this prospective cohort study. Demographic, prenatal, intrapartum and postpartum data were recorded. We investigated the association between childbirth intention, LEA and PPD and assessed the interactions between two factors. Logistic regression analysis was used to screen variables that might be associated with the occurrence of PPD. RESULTS: Overall, 130 of 451 women completing the study at 3 months had PPD (28.8 %). We did not find an association between unmatched childbirth intention, use of LEA and PPD (adjustOR = 0.684 CI 0.335-1.396, p = 0.296; adjustOR = 0.892, CI 0.508-1.565, p = 0.690). Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day numerical rating scale (NRS) score were significantly associated with PPD (p < 0.05). LIMITATIONS: In the 3-month follow-up, we only recorded the EPDS score, not the pain score, and did not evaluate the association between postpartum chronic pain and PPD. CONCLUSIONS: The association between maternal childbirth intention, LEA and PPD was not significant. Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day NRS score were significantly related to the occurrence of PPD (p < 0.05).


Assuntos
Analgesia Epidural , Dor Crônica , Depressão Pós-Parto , Gravidez , Feminino , Humanos , Depressão Pós-Parto/epidemiologia , Estudos Prospectivos , Intenção , Analgésicos , Mães
8.
Wiad Lek ; 75(10): 2416-2418, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36472271

RESUMO

OBJECTIVE: The aim: To evaluate the clinical characteristics of complications and side effects of CSE and DPE as a method of analgesia. PATIENTS AND METHODS: Materials and methods: The study included 137 patients who had a vaginal birth using one of two, CSE or DPE methods of analgesia. All of them were divided into two groups: Group I - 54 women (DPE group) and Group II - 83 women (CSE group). In group I, an epidural kit with a Tuohy G18 needle, G20 catheter, and a Whitacre G25 x 120 mm spinal needle was passed through the epidural needle for puncture of dura mater and removed after cerebrospinal fluid receiving, the epidural catheter was conducted on 3-4 cm. The initial dose of anesthetic was: 3 ml of Naropin 0.12% - test dose and 17 ml of working solution (Naropin 0.12% + Fentanyl 2 µg / ml) - main dose. In group II, a spinal-epidural kit with Tuohy G18 needle, catheter G20, spinal needle "Whitacre" G27 x 132 mm for dura mater puncture was used. Bupivacaine 1.5 mg + Fentanyl 15 mcg, 1 ml solution was administered spinally. To maintain analgesia in both groups - the patient-controlled analgesia with a working solution (Naropin 0.12% + Fentanyl 2 µg / ml) with a bolus of 8 - 10 ml, lockout 15 minutes. RESULTS: Results: The higher frequency of hypotension in childbirth when using CSE - 4 women (4.8%) vs 1 woman (1.9%) in the DPE group. Inadequate or insufficient analgesia in group I was found in 2 women (3.7%), and in group II in 4 women (4.8%). The severity of monolateral block in group I was not high and did not cause significant discomfort in women. The higher incidence of monolateral blockade was in group II, in three cases there was a need for additional anesthesiologist interventions and catheter manipulations. In the CSE group there were two cases (2.4%) of severe itching in women, in group I such an adverse reaction was absent. No complication such as PDPH was documented in either group. CONCLUSION: Conclusions: 1. The use of the DPE technique showed a lower frequency of complications compared to CSE. 2. The use of a G 25 spinal needle for puncture of the dura mater does not lead to an increase in the frequency of PDPH. 3. DPE technique using G25 spinal needles reduces the need for additional manipulations with the epidural catheter to overcome unilateral blockades.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Humanos , Feminino , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Ropivacaina , Bupivacaína , Fentanila , Punções
9.
BMC Anesthesiol ; 22(1): 389, 2022 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-36522711

RESUMO

BACKGROUND: Postpartum depression (PPD) is a serious complication commonly seen in postnatal women. In this paper, an investigation was conducted to see if obstetric anesthesia clinic childbirth course combined with labor epidural analgesia (LEA) was associated with a decreased risk of PPD. METHODS: Six hundred fifty-five nulliparous women were enrolled in this prospective cohort study. The parturients were divided into 4 groups, with Group C being the control group, Group AC received the obstetric anesthesia clinic childbirth course only, Group LEA received LEA only, and Group AC + LEA received both the obstetric anesthesia clinic childbirth course and LEA. Maternal and neonatal variables in the perinatal period were recorded. PPD at 6 weeks was assessed using the Chinese version of the Edinburgh Postpartum Depression Scale (EPDS), where a score ≥ 10 is the threshold for PPD. Multivariate logistic regression analysis was performed to assess the association between obstetric anesthesia clinic childbirth course combined with LEA and postpartum depression. RESULTS: A total of 124 maternities had EPDS ≥10 points, the incidence of PPD was 18.9%。The incidence of PPD and EPDS scores were significantly lower in Group AC + LEA than in Group C (12.1% vs 26.8%, P <  0.05; 6 (5, 7) vs 7 (5, 11), P <  0.05). Received an anesthesia clinic childbirth course combined with LEA was associated with a decreased risk of PPD (OR 0.273, 95% CI, 0.100-0.743, P = 0.013). Multivariate logistic regression analysis identified 5 other independent factors for PPD, including maternal SAS score in the delivery room, W-DEQ score in the delivery room, living in a confinement center, EPDS score at 1st week postpartum and perinatal care satisfaction . CONCLUSIONS: Received an obstetrics anesthesia clinic childbirth course combined with LEA for nulliparous women with a single term cephalic pregnancy was associated with a decreased risk of PPD at 6 weeks. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000039163. Registered on 20/10/2020.


Assuntos
Analgesia Epidural , Anestesia Obstétrica , Depressão Pós-Parto , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/prevenção & controle , Estudos Prospectivos , Analgésicos
10.
Rev. esp. anestesiol. reanim ; 69(10): 632-639, dic. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-211940

RESUMO

Introducción y objetivos: La artroplastia total de cadera (THA) es un procedimiento traumatológico cada vez más común, que comporta dolor postoperatorio de moderado a severo. El bloqueo del grupo de nervios pericapsulares (PENG) es un bloqueo reciente que parece aportar analgesia adecuada sin bloqueo motor significativo. El objeto de este estudio es comparar retrospectivamente la eficacia analgésica y la seguridad del bloqueo PENG y la analgesia epidural, en pacientes sometidos a THA. Material y métodos: Se trata de un estudio retrospectivo observacional durante un periodo de un año de los pacientes sometidos a THA primaria, utilizando analgesia epidural o bloqueo PENG ecoguiado con inyección única. Los datos relativos a las características demográficas, técnicas quirúrgicas y anestésicas, puntuaciones de dolor, consumo de opioides, complicaciones y tiempo hasta el alta hospitalaria se recopilaron de los registros institucionales, comparándose entre los dos grupos (analgesia epidural vs. bloqueo PENG). Resultados: No se encontraron diferencias significativas en cuanto a las puntuaciones de dolor, el consumo de opioides y el tiempo medio hasta el alta hospitalaria entre los dos grupos. Las puntuaciones de dolor en reposo (1,2 epidural vs. 1,67 PENG) o con movimiento (3,95 epidural vs. 3,72 PENG) fueron similares entre ambos grupos. El número total de complicaciones fue superior en el grupo de analgesia epidural (50% epidural vs. 5% PENG). Se reportó parestesia en ambos grupos. Solo se reportaron bloqueo motor, sedación, náuseas y complicaciones relacionadas con el catéter en el grupo de analgesia epidural. Conclusiones: El bloqueo PENG parece ser equivalente a la analgesia epidural en cuanto a calidad de la analgesia postoperatoria para los pacientes sometidos a THA primaria, lo cual respalda el uso rutinario de este bloqueo en estos pacientes. La baja tasa de complicaciones reportadas limita las conclusiones sobre esta cuestión.(AU)


Introduction and objectives: Total hip arthroplasty (THA) is an increasingly common orthopedic pro-cedure, with moderate to severe postoperative pain. Pericapsular nerve group (PENG) block is a recent block that seems to provide adequate analgesia without significant motor blockade. The aim of this study is to retrospectively compare the analgesic efficacy and safety of PENG block with those of epidural analgesia, in patients undergoing THA. Material and methods: This is a retrospective observational study of patients who underwent primary THA, submitted to epidural analgesia or single-shot ultrasound-guided PENG block, during a one-year period. Data regarding demographic characteristics, surgery and anesthesia techniques, pain scores, opioid consumption, complications and time to hospital discharge were retrieved from institutional records and compared between the 2 groups (epidural analgesia vs PENG block). Results: No significant difference was found regarding pain scores, opioid consumption, and mean time to hospital discharge between the 2 groups. Pain scores at rest (1.20 epidural vs 1.67 PENG) or with movement (3.95 epidural vs 3.72 PENG) were similar between groups. Total number of complications was higher in the epidural analgesia group (50% epidural vs 5% PENG). Paresthesia was reported in both groups. Motor block, sedation, nausea and catheter-related complications were only found in the epidural analgesia group. Conclusions: PENG block seems to be equivalent to epidural analgesia regarding quality of postop-erative analgesia for patients subject to primary THA, supporting routine use of this block in these patients. The low rate of reported complications limits conclusions on this topic.(AU)


Assuntos
Humanos , Feminino , Analgesia Epidural , Artroplastia de Quadril , Dor Pós-Operatória , Fraturas do Quadril , Estudos Retrospectivos , Anestesiologia
11.
BMC Anesthesiol ; 22(1): 395, 2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36536284

RESUMO

BACKGROUND: Shoulder pain is commonly reported after hepatic surgery; however, the factors affecting post-hepatectomy shoulder pain remain unclear. This study aimed to determine the incidence and risk factors of shoulder pain after hepatectomy. METHODS: This prospective cohort study recruited 218 patients who underwent hepatic resection at our hospital from June to September 2022. Data were obtained from electronic medical records and follow-up assessments on the second postoperative day. All patients denied chronic pain before surgery. In this cohort study, patients were grouped according to the appearance of shoulder pain. Demographic information and perioperative data were compared between the two groups. The relationship between shoulder pain and independent variables was assessed using univariate binary logistic regression analysis. The potential risk factors were analyzed using multivariable binary logistic regression. RESULTS: Of the 218 patients enrolled in this cohort study, 91 (41.7%) reported shoulder pain. Patients in the case group were significantly younger than those in the control group (P = 0.001). Epidural anesthesia was used more frequently in the case group (P = 0.012). Patients over 60 years of age showed a lower incidence of shoulder pain than younger patients (P = 0.028). According to multivariable binary logistic regression analysis, advanced age and epidural anesthesia were associated with risk of shoulder pain (advanced age: odds ratio [OR] [95% confidence interval (CI)]: 0.96 [0.94, 0.99], P = 0.002; epidural anesthesia: OR [95% CI]: 2.08 [1.18, 3.69], P = 0.012). CONCLUSIONS: The incidence of acute shoulder pain after hepatectomy is 41.7%. The application of epidural anesthesia is an independent risk factor for shoulder pain after hepatectomy, whereas advanced age is a protective factor.


Assuntos
Analgesia Epidural , Humanos , Pessoa de Meia-Idade , Idoso , Estudos de Casos e Controles , Incidência , Estudos de Coortes , Analgesia Epidural/efeitos adversos , Dor de Ombro , Hepatectomia , Estudos Prospectivos , Fatores de Risco , Estudos Retrospectivos
12.
BMC Pregnancy Childbirth ; 22(1): 973, 2022 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-36578025

RESUMO

BACKGROUND: The impact of labor epidural analgesia (LEA) on breastfeeding remains controversial. The aim of this study was to assess the relationship between LEA use and exclusive breastfeeding (EBF) up to 6 months. METHODS: This was a cross-sectional survey on healthy mothers who had vaginal delivery with infants aged 7-12 months from seven maternal health WeChat groups in Jiaxing, China. Data including EBF status up to 6 months, maternal sociodemographic characteristics, LEA use in labor, breastfeeding supports during hospitalization and reasons for stopping EBF were collected using online self-administered questionnaires in October 2021. A multivariable logistic regression model was used to determine the potential association of LEA use with EBF up to 6 months by the adjusted odds ratio (AOR) and 95% confidence interval (CI). RESULTS: Of a total of 537 surveyed mothers, 408 (76.0%) delivered with LEA and 398 (74.1%) exclusively breastfed their infants until 6 months. All mothers delivered in the hospitals with active breastfeeding policies. There was no statistical difference in the rate of EBF up to 6 months between mothers with and without LEA (73.8% versus 75.2%, P = 0.748). Multivariable logistic regression analysis indicated that only increased maternal age (AOR = 0.906, 95% CI 0.854-0.961, P = 0.001) and perceived insufficient breast milk (AOR = 0.129, 95% CI 0.082-0.204, P <  0.001) were associated with lower odds of EBF up to 6 months. The top three reasons for non-EBF were no or insufficient breast milk (41.7%), inability to breastfeed infants after return to work (27.3%), and maternal related factors (24.4%). CONCLUSIONS: LEA does not affect EBF up to 6 months. Other factors such as health education and breastfeeding-friendly hospital strategies may be much more important to breastfeeding outcomes compared to LEA use.


Assuntos
Analgesia Epidural , Aleitamento Materno , Lactente , Feminino , Gravidez , Humanos , Estudos Transversais , Mães , China
13.
PLoS One ; 17(12): e0275716, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36534641

RESUMO

BACKGROUND: Remifentanil patient-controlled analgesia (rPCA) and epidural analgesia (EA) has been used for pain relief in labor. We aimed to evaluate the efficacy and safety of rPCA versus EA in labor, to provide evidence support for clinical analgesia and pain care. METHODS: We searched PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases for RCTs comparing rPCA and EA in labor until February 15, 2022. Two researchers independently screened literature and extracted data. RevMan 5.3 software was used for data analysis. RESULTS: A total of 10 RCTs involving 3086 parturients were enrolled, 1549 parturients received rPCA and 1537 received EA. Meta-analysis indicated that the incidence of intrapartum maternal fever within 1 hour of labor analgesia (OR = 0.43, 95%CI: 0.30~0.62), after 1 hour of labor analgesia (OR = 0.42, 95%CI: 0.20~0.90) in the rPCA was significantly less than that of EA (all P<0.05). The incidence of respiratory depression (OR = 3.56, 95%CI: 2.45~5.16, P<0.001) in the rPCA was significantly higher than that of EA. There were no significant differences in the incidence of Apgar scores<7 at 5 minutes (OR = 1.18, 95%CI: 0.71~1.96, P = 0.53), the patients' satisfaction of pain relief during labor analgesia (SMD = 0.03, 95%CI: -0.40~0.46, P = 0.90) between rPCA and EA (all P>0.05). CONCLUSION: rPCA can be an optional alternative to EA with similar pain relief and less risk of intrapartum maternal fever. However, rPCA was associated with increased risk of respiratory depression. Future studies with rigorous design and larger sample size are needed to provide more reliable evidences for clinical rPCA and EA use.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Dor do Parto , Gravidez , Feminino , Humanos , Remifentanil , Analgesia Epidural/efeitos adversos , Analgésicos Opioides , Analgesia Controlada pelo Paciente
14.
Medicine (Baltimore) ; 101(45): e31684, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397414

RESUMO

BACKGROUND: Postoperative pain after open thoracotomy is known to be very severe and affects sleep quality. This study aimed to investigate the effects of a programmed intermittent epidural bolus injection versus continuous epidural injection for controlling nighttime pain and improving sleep quality after thoracotomy. METHODS: Seventy-six patients scheduled for open thoracotomy for lung cancer or other lung diseases were enrolled. The participants were divided into 2 groups. Group A was continuously injected with 0.2% levobupivacaine at 1.1 mL/h, and group B was injected intermittently with 3 mL 0.2% levobupivacaine at 3 hours intervals through a thoracic epidural catheter via a programmed infusion pump. Within 48 hours after surgery, the degree of pain control using visual analog scale and the patients' sleep conditions on postoperative day (POD) 0 and 1 were evaluated, and other adverse events were investigated. RESULTS: On POD 1 night, the visual analog scale in group B showed lower than group A (P = .009). Comparison of time to fall asleep showed no differences between 2 groups. Total sleep time was no difference on POD 0 but was longer in group B than that in group A on POD 1 (P = .042). Awakening from sleep on POD 0 was lower in group B than that in group A (P = .033), and satisfaction with sleep quality on POD 0 was superior in group B compared to group A (P = .005). Postoperative nausea and vomiting occurred more frequently in group B than in group A (P = .018). CONCLUSION: The programmed intermittent epidural bolus technique of patient-controlled epidural analgesia reduces postoperative nighttime pain and improves sleep quality in patients undergoing thoracotomy for lung cancer or other lung diseases.


Assuntos
Analgesia Epidural , Pneumopatias , Neoplasias Pulmonares , Humanos , Toracotomia/efeitos adversos , Levobupivacaína , Analgesia Epidural/métodos , Qualidade do Sono , Injeções Epidurais , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Neoplasias Pulmonares/etiologia , Pneumopatias/etiologia
15.
Br J Anaesth ; 129(6): 946-958, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36404458

RESUMO

BACKGROUND: Preemptive analgesia may improve postoperative pain management, but the optimal regimen is unclear. This study aimed to compare the effects and adverse events of preemptive analgesia on postoperative pain and opioid consumption. METHODS: In this network meta-analysis, 19 preemptive analgesia regimens were compared. Two authors independently searched databases, selected studies, and extracted data. Primary outcomes were the intensity of postoperative pain and opioid consumption. Secondary outcomes included the time to first analgesia rescue and incidence of postoperative nausea or vomiting (PONV). RESULTS: In total, 188 studies were included (13 769 subjects). Ten of 19 regimens reduced postoperative pain intensity compared with placebo, with mean differences 100-point scale ranging from -4.79 (95% confidence interval [CI]: -8.61 to -0.96.) for gabapentin at 48 h to -21.99 (95% CI: -36.97 to -7.02) for lornoxicam at 6 h. Eight regimens reduced opioid consumption compared with placebo, with mean differences ranging from -0.48 mg (95% CI: -0.89 to -0.08) i.v. milligrams of morphine equivalents (IMME) for acetaminophen at 12 h to -2.27 IMME (95% CI: -3.07 to -1.46) for ibuprofen at 24 h. Five regimens delayed rescue analgesia from 1.75 (95% CI: 0.59-2.91) h for gabapentin to 7.35 (95% CI: 3.66-11.04) h for epidural analgesia. Five regimens had a lower incidence of PONV compared with placebo, ranging from an odds ratio of 0.22 (95% CI: 0.11-0.42) for ibuprofen to 0.59 (95% CI: 0.40-0.87) for pregabalin. CONCLUSIONS: Use of preemptive analgesia reduces postoperative pain, opioid consumption, and postoperative nausea or vomiting, and delays rescue analgesia. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42021232593.


Assuntos
Analgesia Epidural , Náusea e Vômito Pós-Operatórios , Humanos , Analgésicos Opioides , Gabapentina/uso terapêutico , Ibuprofeno/uso terapêutico , Metanálise em Rede , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/induzido quimicamente , Náusea e Vômito Pós-Operatórios/induzido quimicamente
17.
BMC Anesthesiol ; 22(1): 352, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36380286

RESUMO

BACKGROUND: Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature. METHODS: Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded. RESULTS: Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group. CONCLUSION: Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia. TRIAL REGISTRATION: ChiCTR1900026606 . Registered on 16/10/2019.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestesia Epidural , Recém-Nascido , Feminino , Humanos , Temperatura , Febre , Anestésicos Locais
19.
BMC Anesthesiol ; 22(1): 341, 2022 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344910

RESUMO

BACKGROUND: Thoracic epidural analgesia (TEA) has always been the first choice for postoperative pain treatment, but associated complications and contraindications may limit its use. Our study put forward a new analgesic strategy that combines TEA with patient controlled intravenous analgesia (PCIA) to optimize TEA. METHODS: Patients undergoing laparotomy were enrolled in this prospective randomized study. Patients were randomized to one of two groups: TEA/PCIA group and TEA group. Patients in TEA/PCIA group received TEA in the day of surgery and the first postoperative day and PCIA continued to use until the third postoperative day. Patients in TEA group received TEA for three days postoperatively. Visual analogue scale (VSA) pain scores at rest and on movement at 6, 24,48,72 h after surgery were recorded. In addition, the incidence of inadequate analgesia, adverse events, time to first mobilization, time to pass first flatus, time of oral intake recovery, time of urinary catheter removal, postoperative length of hospital stay, cumulative opioid consumption, and the overall cost were compared between the two groups. We examined VAS pain scores using repeated measures analysis of variance; P < 0.05 was considered as statistically significant. RESULTS: Eighty-six patients were analysed (TEA/PCIA = 44, TEA = 42). The mean VAS pain scores at rest and on movement in TEA/PCIA group were lower than TEA group, with a significant difference on movement and 48 h postoperatively (P < 0.05). The time to first mobilization and pass first flatus were shorter in TEA/PCIA group (P < 0.05). Other measurement showed no statistically significant differences. CONCLUSIONS: The combination of TEA with PCIA for patients undergoing laparotomy, can enhance postoperative pain control and facilitate early recovery without increasing the incidence of adverse effects and overall cost of hospitalization. TRIAL REGISTRATION: Chinese Clinical Trial Registry( www.chictr.org.cn ), ChiCTR 1,800,020,308, 13 December 2018.


Assuntos
Analgesia Epidural , Humanos , Analgesia Epidural/efeitos adversos , Laparotomia , Estudos Prospectivos , Flatulência/tratamento farmacológico , Flatulência/etiologia , Analgesia Controlada pelo Paciente , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Analgésicos Opioides
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