Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were double-blind comparison of % bupivacaine/% fentanyl versus. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were bupivacaine % plus sufentanil µg·mL−1: a study. Presented in part at the Society for Obstetric Anesthesia and boluses of bupivacaine % + fentanyl 2 −1 as part of a programmed.

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On the other hand, CSE may reduce accidental dural puncture rates.

Epidural analgesia in labour | BJA Education | Oxford Academic

Epidural analgesia does not increase caesarean section rates. The total dose of LA and opioid is actually increased when compared with low dose top-ups. Bearing in mind the above, how can we optimize labour epidural analgesia to ensure superior analgesia while minimizing the effects on labour? In a drive to decrease instrumental deliveries, ever-lower dose regimens have been studied and found to provide effective analgesia.

Obstetri are the traditional intermittent boluses of LA, typically bupivacaine obstegric. Epidurals do not increase caesarean section rates or the incidence of back pain. Nulliparity and obwtetric longer than 12 h were also independent predictors for maternal pyrexia.

Epidurals have been credited with prolonging labour; increasing oxytocin requirements, instrumental and operative delivery rates; and causing maternal pyrexia and postpartum back pain.


After childbirth there obsteric no difference in the incidence of long-term back pain, disability or movement restriction between women who have obstetrric and those who have not. Uterine activity appears to be unaffected by induction of regional block.

It undergoes ester hydrolysis; minimizing placental transmission but its duration of action is too short for analgesia. Key points Compared with other methods, epidural analgesia provides superior analgesia in labour. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. The clinical relevance of this is unclear. Perioperative Management All Journals search input.

Pain relief and anaesthesia in obstetrics. It has been suggested that confining women to bed during labour may cause labour to be longer and more painful, and increase the incidence of malpresentations and therefore instrumental deliveries. Traditionally, bupivacaine has been the most widely used LA in the UK. In practise, LDI provide adequate analgesia and cardiovascular stability but do not decrease anaesthetic workload when compared with midwife top ups as failure of analgesia requires increased anaesthetic intervention.

CJA ; 51 6: Patient-controlled epidural analgesia PCEA has proved a safe and reliable technique.

The low-dose regimen provides effective, rapid onset analgesia and high maternal satisfaction rates when compared with traditional top-ups. Sign In or Create an Account. Morphine, a relatively long-acting opioid, is poorly lipid soluble and may accumulate in the CSF where it can spread cephalad, potentially causing late respiratory depression.


Study design is significant when assessing the evidence. In the UK, a popular combination for epidural infusions or bolus top-ups is a solution of bupivacaine 0.

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CJA ; 50 6: Abstract Since epidural analgesia was introduced four decades ago for pain relief in labour, controversy has persisted about its effect on the labour process. In theory, LDI should decrease anaesthetic workload, provide more constant analgesia and better haemodynamic stability and sterility. A double-blind comparison of 0. A comparison of ovstetric. Extradural pain relief in labour: Sufentanil is used extensively in the US.

We have a duty to provide optimal analgesia during labour. Formal scoring methods, such as the Bromage score, straight leg raise or proprioception assessment, can be used to assess the mother’s ability to walk safely. The onset of analgesia obstegric significantly faster in 0. Compared with other methods, epidural analgesia provides superior analgesia in labour.