Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report.

Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Catéter epidural seccionado: reporte de un caso y revisión de literatura / Sectioned epidural catheter: a case report and review of literature / Ruptura de cateter epidural: relato de caso e revisão da literatura

Resumen: La ruptura y retención de un fragmento de catéter peridural es una complicación poco frecuente de la analgesia epidural. Si bien generalmente requiere una conducta expectante con evolución sin mayores complicaciones, su importancia está dada por la escasa evidencia en cuanto al manejo, teniendo en cuenta que puede derivar en una intervención neuroquirúrgica, con sus riesgos y complicaciones. Exponemos el caso de una paciente que tuvo como complicación la ruptura y retención de un fragmento de catéter peridural durante la colocación del mismo para analgesia del parto.

Summary: Rupture and retention of an epidural catheter fragment is a rare complication of epidural analgesia. Although it generally requires expectant management and evolves without major complications, the event is important given the lack of evidence regarding treatment and considering it can lead to a neurosurgical intervention, what involves risks and complications. The study describes the case of a patient whose complication was the rupture and retention of a fragment of an epidural catheter during labor analgesia.

Resumo: A ruptura e retenção de um fragmento de cateter epidural é uma complicação rara da analgesia epidural. Embora geralmente exija uma gestão expectante com evolução sem grandes complicações, a importância é dada pela escassa evidência relativa ao manejo, considerando que pode levar à uma intervenção neurocirúrgica, com os correspondentes riscos e complicações. Apresentamos o caso de uma paciente cuja complicação foi a ruptura e retenção de um fragmento de cateter epidural durante sua colocação para analgesia do parto.

Effectiveness of the peanut ball use for women with epidural analgesia in labour: a systematic review and meta-analysis.

This meta-analysis aimed to evaluate, using the best level of evidence, the possible benefits and advantages of using peanut ball (PB) in women with an epidural during labour on the maternal and neonatal outcomes. This research was conducted using MEDLINE/PubMed, Embase, LILACS, CINAHL, CENTRAL, PEDro, Web of Science and SCOPUS databases, with no period or language restrictions. The terms 'labor' and 'peanut ball' were used. Clinical trials (randomised and non-randomised) were included when comparing a group of parturients using PB with a control group under usual care. Randomised clinical trials (RCTs) or quasi-randomised were eligible for this systematic review. Two reviewers independently screened studies, extracted data and assessed the quality of evidence which was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applied whenever possible. In this updated review, we included four studies with a total of 818 women in labour after the use of pharmacological analgesia. Our GRADE ratings of evidence ranged from high to low quality. Overall, the included studies varied in their risk of bias, in which most were considered with some concerns. There is high evidence that the use of PB after epidural analgesia reduces the duration of the first period of labour by 87 minutes and moderate evidence that it increases the chance of vaginal delivery 11%. However, there is no evidence about other maternal and neonatal outcomes.Impact StatementWhat is already known on this subject? The peanut ball (PB) is used after the use of pharmacological analgesia, as it favours the opening of the pelvic canal and helps women to adopt more comfortable postures, but its real effects are not clear.What do the results of this study add? Our results suggest that using the PB reduces the duration of the first period of labour after an epidural and increases the chance of a vaginal birth.What are the implications of these findings for clinical practice and/or further research? These findings recommend the use of a PB after an epidural and further research with women without the use of pharmacological analgesia.

Efetividade das essências florais no trabalho de parto e nascimento: avaliação dos parâmetros obstétricos e neuroendócrinos / Efectividad de las esencias florales en el trabajo de parto y nacimiento: evaluación de los parámetros obstétricos y neuroendócrinos / Effectiveness of flower essences in labor and birth: evaluation of obstetric and neuroendocrine parameters

Resumo Objetivo Avaliar a efetividade da terapia floral associados aos fatores que potencializam a dor e o estresse no processo de parturição por meio de parâmetros obstétricos e neuroendócrinos. Métodos Ensaio clínico randomizado, triplo cego, placebo controlado, realizado com 164 parturientes de risco obstétrico habitual, subdivididas entre dois grupos para as quais foram ministradas essência floral Five Flower e placebo, respectivamente. Avaliou-se aspectos obstétricos e neuroendócrinos por meio da análise bioquímica dos hormônios Beta-endorfina e Cortisol salivar antes e ao término da intervenção. Resultados A essência floral modulou os fatores que potencializam a dor no trabalho de parto, isto é, rotura das membranas amnióticas, fase ativa e indução do parto. Houve aumento dos níveis de Beta-endorfina juntamente com a diminuição de uma contração em mulheres com rotura das membranas ovulares e com indução. Em relação ao estresse, houve constância dos valores do Cortisol para o Grupo Experimental, não alterando seu valor na fase ativa, rotura das membranas ovulares ou indução. A Essência Five Flower mostrou-se eficaz na redução de uma hora e vinte e cinco minutos do tempo do trabalho de parto no Grupo Experimental. Conclusão A terapia floral realizada, mostrou-se eficaz no controle da dor e estresse durante o trabalho de parto, refletindo positivamente na sua brevidade e qualificando seu desfecho.

Resumen Objetivo Evaluar la efectividad de la terapia floral asociada a los factores que potencializan el dolor y el estrés en el proceso de parto por medio de parámetros obstétricos y neuroendócrinos. Métodos Ensayo clínico aleatorizado, triple ciego, placebo controlado, realizado con 164 parturientas de riesgo obstétrico normal, subdivididas en dos grupos en que se les administró esencia floral Five Flower y placebo. Se evaluaron aspectos obstétricos y neuroendócrinos por medio del análisis bioquímico de las hormonas betaendorfina y cortisol salival antes y al final de la intervención. Resultados La esencia floral reguló los factores que potencializan el dolor en el trabajo de parto, es decir, ruptura de las membranas amnióticas, fase activa e inducción del parto. Hubo aumento de los niveles de betaendorfina junto con la reducción de una contracción en mujeres con ruptura de las membranas ovulares y con inducción. Con relación al estrés, hubo constancia de los valores de cortisol en el grupo experimental, sin aumento de su valor en la fase activa, ruptura de las membranas ovulares o inducción. La esencia Five Flower demostró ser eficaz para la reducción de una hora y veinticinco minutos de tiempo de trabajo de parto en el grupo experimental. Conclusión La terapia floral realizada demostró ser eficaz en el control del dolor y del estrés durante el trabajo de parto, con un impacto positivo en su brevedad y en la cualificación de su desenlace.

Abstract Objective To evaluate the effectiveness of floral therapy associated with factors that strengthen pain and stress in the labor process through obstetric and neuroendocrine parameters. Methods Randomized, triple-blind, placebo-controlled clinical trial performed with 164 parturients at usual obstetric risk subdivided into two groups to which Five Flower floral essence and placebo were administered. Obstetric and neuroendocrine aspects were evaluated through biochemical analysis of the beta-endorphin and cortisol hormones through salivary samples before and after the intervention. Results The flower essence modulated the factors that strengthen pain in labor, that is, rupture of amniotic membranes, active phase and induction of labor. There was an increase in beta-endorphin levels along with one less contraction in women with ruptured ovular membranes and labor induction. Regarding stress, cortisol values were constant for the Experimental group, and did not change in the active phase, rupture of the ovular membranes or induction. The Five Flower essence proved to be effective in reducing labor time by 1 hour 25 minutes in the Experimental group. Conclusion The floral therapy used proved to be effective in controlling pain and stress during labor, and reflected positively on its agility and qualified its outcome.

Morfina intratecal en analgesia poscesárea / Intratecal morphine in cesarian section

The Cesarean section is the most frequently performed surgical intervention in most countries, in Chile there are approximately 80,000 cases per year. In the postoperative period, effective analgesia is essential since patients define the absence of intra- and post-cesarean pain as priorities. On the other hand, entities such as cronical pain and postpartum depression have been associated with persistent postoperative pain and difficulty in mother-child interaction. Intrathecal morphine (ITM) was first described in obstetric analgesia in the 1980s and has since become widely used for post-cesarean section analgesia due to its prolonged analgesic action. In this review we will focus on the most relevant aspects that may lead to the incorporation of MIT in the Analgesia protocols for Cesarean section in our country.

La Operación Cesárea es la intervención quirúrgica más frecuentemente realizada en la mayoría de los países, en Chile son aproximadamente 80.000 casos por año. En su posoperatorio la analgesia eficaz es fundamental, dado que las pacientes definen la ausencia de dolor intra y poscesárea como prioritarios. Por otra parte, entidades como dolor cónico y depresión posparto han sido asociados con dolor posoperatorio persistente y dificultad en la interacción madre-hijo. La morfina intratecal (MIT) se describió por primera vez en analgesia obstétrica en la década de 1980 y desde entonces se ha vuelto ampliamente utilizada para la analgesia poscesárea debido a su prolongada acción analgésica. En esta revisión nos centraremos en los aspectos más relevantes que puedan conducir a la incorporación de MIT en los protocolos de Analgesia para Cesárea en nuestro país.

Incidencia de alteraciones de la frecuencia cardíaca fetal tras la inducción de analgesia del parto neuroaxial / Incidence of fetal heart rate abnormalities after neuroaxial labor analgesia induction

OBJECTIVE: To assess changes in fetal heart rate variability (FHR) after induction of neuraxial labor analgesia. MATERIALS AND METHODS: Prospective analytical cohort clinical trial conducted between July 2020 and July 2021, with fifty-nine pregnant women from the Pereira Rossell Hospital Center (CHPR) who met the inclusion criteria. Analgesic technique (epidural/spinal epidural) was randomly assigned. FHR, maternal blood pressure (BP), intensity of uterine contraction in Montevideo Units (UM) and pain using a verbal numerical scale (VAS) were monitored for 20 minutes. RESULTS: No statistically significant differences were observed for FHR at each of the times, and there were no cases of fetal bradycardia. In PA and UM, no statistically significant differences were observed. No statistically significant differences were observed for VAS at each of the times, except immediately after receiving analgesia, p value = 0.046. CONCLUSIONS: CSE was not associated with a higher risk of FHR alterations. Intrathecal fentanyl at a maximum dose of 15 mcg is safe and effective in relieving labor pain. Pain relief was similar for the two groups. No episodes of hypotension were observed. Both techniques are effective for pain relief with a similar safety profile when low doses of intraspinal fentanyl are used.

OBJETIVO: Valorar las alteraciones de la variabilidad de la frecuencia cardíaca fetal (FCF) luego de la inducción de analgesia del parto neuroaxial. MATERIALES Y MÉTODOS: Ensayo clínico prospectivo analítico de cohortes realizado entre julio de 2020 y julio de 2021, con 59 embarazadas del Centro Hospitalario Pereira Rosell (CHPR) que cumplieron con los criterios de inclusión. Se asignó de forma aleatoria la técnica analgésica (epidural/espinal-epidural). Se monitorizó durante 20 minutos la FCF, presión arterial materna (PA), intensidad de la contracción uterina en Unidades Montevideo (UM) y dolor mediante escala numérica verbal (EVA). RESULTADOS: Para la FCF en cada uno de los tiempos no se observaron diferencias estadísticamente significativas, ni hubo casos de bradicardia fetal. En la PA y UM no se observaron diferencias estadísticamente significativas. Para la EVA en cada uno de los tiempos no se observaron diferencias estadísticamente significativas, excepto inmediatamente a recibir la analgesia, valor p = 0,046. CONCLUSIONES: La CSE no se asoció a mayor riesgo de alteraciones de la FCF. El fentanil intratecal a dosis máxima de 15 mcg es seguro y efectivo para calmar el dolor del trabajo de parto. El alivio del dolor fue similar para los 2 grupos. No se observaron episodios de hipotensión. Ambas técnicas son eficaces para el alivio del dolor con similar perfil de seguridad cuando se usan dosis bajas de fentanil intrarraquídeo.

Técnicas regionales guiadas por ultrasonido para manejo de analgesia para cesárea / Ultrasound regional analgesic technic for cesarian analgesia

One of the fundamental pillars for optimal patient recovery after a cesarean section is pain management after a surgical intervention. For years the gold standard for analgesic management the use of intrathecal morphine due to its long-lasting effect, however adverse effects related to the use of opioids are evidenced too, Currently, with the advent of multimodal analgesia, the use of opioids and the effects associated with them have been reduced, optimizing pain management, reducing hospital stay, lower risk of postpartum depression, reducing the presence of nausea and vomiting as well as pruritus and improving mother-child relationship. An essential component of the multimodal analgesia are regional blocks like the transversus abdominis plane block and the ilioinguinal / iliohypogastric block, Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless these have a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrate better outcomes compare with intrathecal morphine.

Uno de los pilares fundamentales para la recuperación de la paciente que fue intervenida de cesárea es el manejo del dolor posoperatorio. Por años el estándar de oro ha sido el uso de la morfina intratecal considerando su larga duración como también los efectos adversos, actualmente con el advenimiento de la analgesia multimodal, se ha reducido el uso de opiodes y de los efectos asociados a estos optimizando el manejo del dolor, disminuyendo la estancia hospitalaria, menor riesgo de depresión posparto, disminuye la presencia de náusea y vómitos como también prurito y mejorando la relación madre e hijo. Un componente esencial de la analgesia multimodal son los bloqueos: transverso del abdomen, ilioinguinal/ iliohipogástrico, cuadrado lumbar, erector de la espina; que han aportado eficazmente en el abordaje del dolor posoperatorio. El bloqueo de los planos y demuestra su utilidad con un mejor manejo del dolor en comparación con el bloqueo TAP, a pesar de que estos tienen un mayor nivel de complejidad debido al control del dolor visceral; pero no hay evidencia con suficiente calidad metodológica que demuestre mejores resultados en comparación con la morfina intratecal.

Complicaciones neurológicas e infecciones tras analgesia neuroaxial del parto / Neurologic complications and infections after neuraxial analgesia for labor

Most peripartum neurological complications are due to compressive neuropathy secondary to obstetric causes and usually recover sponta- neously. The incidence of permanent neurological injury after neuraxial anesthesia is very rare. The suspicion and rapid evaluation of a possible complication favors a good outcome.

La mayoría de las complicaciones neurológicas periparto se deben a una neuropatía compresiva secundaria a causas obstétricas que habitualmente se recuperan espontáneamente. La incidencia de lesión neurológica permanente después de la anestesia neuroaxial es muy infrecuente. La sospecha y rápida evaluación de una posible complicación favorece un buen desenlace.

Association of postpartum depression and epidural analgesia in women during labor: an observational study.

BACKGROUND AND OBJECTIVES: Postpartum depression affects women, manifesting with depressed mood, insomnia, psychomotor retardation, and suicidal thoughts. Our study examined if there is an association between epidural analgesia use and postpartum depression. METHODS: Patients were divided into two groups. One group received epidural analgesia during labor while the second group did not. The Edinburgh postnatal depression scale (EPDS) was administered to patients prior to birth and 6 weeks postpartum. Pain severity was assessed by the Visual Analogue Scale (VAS) during labor and at 24hours postpartum. RESULTS: Of the 92 patients analyzed, 47.8% (n=44) received epidural analgesia. We detected significantly higher VAS score during labor (p= 0.007) and 24 hours postpartum (p = 0.0001) in the group without epidural analgesia. At 6 weeks postpartum, a significant difference was observed between the EPDS scores of both groups (p= 0.0001). Regression analysis revealed higher depression scores in patients experiencing higher levels of pain during labor (OR = 0.572, p= 0.039). Epidural analgesia strongly correlated with lower scores of depression (OR = 0.29, p= 0.0001). CONCLUSION: The group that received epidural analgesia had lower pain scores. A high correlation between epidural analgesia and lower depression levels was found. Pregnant women giving birth via the vaginal route and having high pain scores could reduce postnatal depression scores using epidural labor analgesia. Pregnant women should opt for epidural analgesia during labor to lessen postpartum depression levels.

Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital.

BACKGROUND AND OBJECTIVES: Obesity is becoming a frequent condition among obstetric patients. A high body mass index (BMI) has been closely related to a higher difficulty to perform the neuraxial technique and to the failure of epidural analgesia. Our study is aimed at analyzing obese obstetric patients who received neuraxial analgesia for labor at a tertiary hospital and assessing aspects related to the technique and its success. METHODS: Retrospective observational descriptive study during one year. Women with a BMI higher than 30 were identified, and variables related to the difficulty and complications of performing the technique, and to analgesia failure rate were assessed. RESULTS AND CONCLUSIONS: Out of 3653 patients, 27.4% had their BMI ≥ 30 kg.m-². Neuraxial techniques are difficult to be performed in obese obstetric patients, as showed by the number of puncture attempts (≥ 3 in 9.1% obese versus 5.3% in non-obese being p < 0.001), but the incidence of complications, as hematic puncture (6.6%) and accidental dural puncture (0.7%) seems to be similar in both obese and non-obese patients. The incidence of cesarean section in obese patients was 23.4% (p <  0.001). Thus, an early performance of epidural analgesia turns out to be essential to control labor pain and to avoid a general anesthesia in such high-risk patients.

Revisión de evidencia del impacto de la anestesia obstétrica en los desenlaces maternos y neonatales. Un análisis de la literatura / Review of evidence of the impact of obstetric anesthesia on maternal and neonatal outcomes. An analysis of the literature

We present the analysis and comments of a review of evidence of the impact of obstetric anesthesia on maternal and neonatal outcomes, based on an article previously published by Lim et al.[1]. The advances in obstetric anesthesia on analgesia and anesthesia for labor and delivery, anesthesia for cesarean section and outcomes in obstetric anesthesia.

Se presenta el análisis y comentarios de una revisión de evidencia del impacto de la anestesia obstétrica en los desenlaces maternos y neonatales, basado en un artículo previamente publicado por Lim y cols.[1]. Se analizan los avances en la anestesiología obstétrica sobre analgesia y anestesia para el parto, anestesia para cesárea y desenlaces en anestesia obstétrica.

Complementary and alternative therapies for post-caesarean pain.

BACKGROUND: Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain. OBJECTIVES: To assess the effects of CAM for post-caesarean pain. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. MAIN RESULTS: We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women). AUTHORS' CONCLUSIONS: Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.

Obstetric analgesia in labor and its association with neonatal outcomes.

OBJETIVE: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. METHOD: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. RESULTS: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. CONCLUSION: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.