OBJECTIVE: To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section. METHODS: We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations. RESULTS: A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3%) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% CI: 1.057-1.132, P < 0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% CI: 1.011-1.124, P=0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% CI: 1.103-2.341, P < 0.001). CONCLUSION Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.
Analgesia, Epidural/adverse effects* ; Analgesia, Obstetrical/adverse effects* ; Anesthesia, Obstetrical ; Cesarean Section ; Child ; Female ; Humans ; Pregnancy ; Retrospective Studies

OBJECTIVETo investigate the changes and influence factors for early postoperative pulmonary function of thoracotomy.

METHODSPre- and early postoperative pulmonary function was detected in 64 consecutive cases with optimal thoracotomy. Pain assessment was conducted before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were made and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed using SPSS10.0 medical statistic software.

RESULTSPulmonary function was severely lowered to (39 +/- 14)% of the base line on the first day. It was rehabilitated gradually, and recovered to (62 +/- 10)% of the base line on the 8th day. Epidural analgesia could improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influence factors for early postoperative pulmonary function. Multiple-factor analysis showed that preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it.

CONCLUSIONSEarly postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that will reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.

Analgesia, Epidural ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Multivariate Analysis ; Pain ; physiopathology ; Thoracotomy ; adverse effects

BACKGROUNDA wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1% ropivacaine on the maternal temperature during labor.

METHODSTwo hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 µg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the above mentioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes.

RESULTSEpidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.

CONCLUSIONEpidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

Adult ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Epidural ; adverse effects ; Analgesia, Obstetrical ; adverse effects ; Body Temperature ; drug effects ; Female ; Fever ; chemically induced ; Humans ; Labor, Obstetric ; Pregnancy ; Young Adult

OBJECTIVETo investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture.

METHODSPatients scheduled to have transurethral prostatic resection: enrolled in the study (69 patients), characterized as Grade II or III by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group: the placebo group (control group), non-anesthesia area (NAA) group, and the anesthesia area (AA) group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed.

RESULTSAltogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study,: twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group (P<0.05). There was a significant decrease of the incidence for itchiness in the NAA group compared with

CONCLUSIONSOn the basis of this study, it is obviously seen that acupuncture could: decrease the incidence of morphine-related side effects (nausea and vomiting, itchiness and gastrointestinal disorders) when the spinal cord conduct is normal. However, it decreases only the incidence of itchiness but not for gastrointestinal dysfunction when the spinal cord is blocked.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Analgesia ; adverse effects ; Analgesia, Epidural ; adverse effects ; Anesthesia, Epidural ; adverse effects ; methods ; Anesthesia, Spinal ; adverse effects ; methods ; Humans ; Intestines ; physiopathology ; Male ; Middle Aged ; Morphine ; administration & dosage ; adverse effects ; Postoperative Complications ; prevention & control ; Postoperative Nausea and Vomiting ; prevention & control ; therapy ; Prostatic Hyperplasia ; physiopathology ; surgery ; Pruritus ; therapy ; Transurethral Resection of Prostate ; rehabilitation ; Treatment Outcome

OBJECTIVETo investigate the effects, side-effects and security of bupivacaine, ropivacaine combined with fentanyl in postoperative continuous epidural analgesia.

METHODSA total of 1 600 postoperative continuous epidural analgesia patients receiving different agents in SICU were divided into two groups: 0.1% bupivacaine +5 microg/ml fentanyl group (group B, n = 920) and 0.2% ropivacaine +2 microg/ml fentanyl group (group R, n = 680). The effects (visual analog-scale score and content to analgesia), side effects were analyzed retrospectively in the two groups.

RESULTSCompared with group B, patients in group R had higher analgesia contentment (P < 0.05), but no difference in visual analog-scale score was found in the two groups. The incidences of urinary retention, nausea and vomiting, skin itching in group B were significantly higher than those in group R (P < 0.05). In each group, patients over sixty had higher ratio of hypotension than those under sixty (P < 0.05); The female patients had a higher incidence of nausea and vomiting than male patients (P < 0.05); The incidence of debility and numbness of lower limbs in patients with lumbar segments epidural analgesia was higher than those with thoracic analgesia (P < 0.05).

CONCLUSIONS0.1% bupivacaine +5 microg/ml fentanyl and 0.2% ropivacaine +2 microg/ml fentanyl can provide adequate pain relief in postoperative continuous epidural analgesia, and 0.2% ropivacaine +2 microg/ml fentanyl comes with less side effects. The incidence of complication is related with analgesics, age, gender and the position of epidural puncture.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amides ; administration & dosage ; adverse effects ; Analgesia, Epidural ; adverse effects ; methods ; Analgesia, Obstetrical ; adverse effects ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; Anesthetics, Local ; administration & dosage ; adverse effects ; Bupivacaine ; administration & dosage ; adverse effects ; Female ; Fentanyl ; administration & dosage ; adverse effects ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; prevention & control ; Retrospective Studies

Adolescent ; Adult ; Aged ; Amides ; adverse effects ; Analgesia ; Anesthesia, Epidural ; Bradycardia ; chemically induced ; Double-Blind Method ; Humans ; Hypotension ; chemically induced ; Hysterectomy ; Mesylates ; adverse effects ; Middle Aged ; Pain, Postoperative ; drug therapy ; Postoperative Period

OBJECTIVETo compare efficacy and side effects of patient-controlled epidural analgesia (PCEA) with levobupivacaine, ropivacaine and racemic bupivacaine after cesarean section.

METHODSIn this prospective, randomized double-blind study, 90 ASA I-II full-term nulliparous women (aged 25-38 years with body weight of 59-87 kg) undergoing elective cesarean section under spinal-epidural anesthesia equally allocated into 3 groups. PCEA was administered with 0.125% levobupivacaine and 20 microg/ml morphine (group L, n=30), 0.125% ropivacaine and 20 microg/ml morphine (group R, n=30), and 0.125% bupivacaine and 20 microg/ml morphine (group B, n=30), respectively. The Visual Analog Scale (VAS) score, satisfaction rate, patients' overall impression of treatment, modified Bromage motor score, and incidence of side effects were recorded at regular intervals after operation.

RESULTSThe three groups were comparable with respect to the efficacy of analgesia, patients' overall impression of treatment, motor blockade and side effects. There was significant difference in patients' satisfaction rate between group R (70%) and the other two groups (93.3% in group L and 96.6% in group B, P<0.05).

CONCLUSIONPCEA with 0.125% levobupivacaine and morphine 20 microg/ml produces better analgesic effect with little side effects after cesarean section.

Adult ; Amides ; administration & dosage ; adverse effects ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Bupivacaine ; administration & dosage ; adverse effects ; analogs & derivatives ; Cesarean Section ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Morphine ; administration & dosage ; Nausea ; chemically induced ; Pregnancy ; Prospective Studies ; Pruritus ; chemically induced ; Treatment Outcome ; Vomiting ; chemically induced

OBJECTIVETo investigate the changes and influencing factors of early postoperative pulmonary function of thoracotomy.

METHODSPre- and early postoperative pulmonary function was studied in 64 consecutive cases with optimal thoracotomy. Pain assessment was done before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were done and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed.

RESULTSPulmonary function was severely lowered to about 40% of the base line on the first day, and it was rehabilitated to about 60% of the base line on the eighth day. There was a greater gradient on the recovery curve on the 3rd and 4th days. Epidural analgesia was able to improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influencing factors for early postoperative pulmonary function. By multiple-factor analysis, preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it.

CONCLUSIONSEarly postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that would reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.

Adult ; Age Factors ; Aged ; Analgesia, Epidural ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; physiopathology ; therapy ; Postoperative Period ; Respiratory Function Tests ; Thoracotomy ; adverse effects ; Vital Capacity

OBJECTIVETo evaluate the efficacy and safety of continuous epidural analgesia (CEA) with butorphanol in elderly patients undergoing hip replacement.

METHODSSixty patients scheduled for selective hip replacement were randomized into group B (n=30) to receive patient-controlled epidural analgesia (PCEA) with butorphanol and group M (n=30) to receive PCEA with morphine. Their pain distribution at 5 time points, postoperative global score and the adverse effects in 48 h were observed.

RESULTSThe pain distribution at the 5 time points or the global score for postoperative PCEA in 48 h showed no statistically significant difference between the two groups (P<0.05). Analgesia with butorphanol caused less adverse effects (respiratory depression, nausea and vomiting, itching and abdominal distension) than that with morphine (P<0.05).

CONCLUSIONCEA with butorphanol is safe and effective for the treatment of postoperative pain in elderly patients and causes less adverse effects than morphine.

Aged ; Aged, 80 and over ; Analgesia, Epidural ; Arthroplasty, Replacement, Hip ; adverse effects ; Butorphanol ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Morphine ; administration & dosage ; therapeutic use ; Pain, Postoperative ; etiology ; prevention & control

PURPOSE: Several analgesic techniques are available for pain management after a major operation. MATERIALS AND METHODS: From December 2005 to February 2006, a prospective, double-blind study was performed involving 90 patients who had undergone a total knee arthroplasty. Patients were randomly divided into three equal groups (n=30). Demographic data, including age, height, weight, knee score, visual analogue scale (VAS), and range of flexion were evaluated preoperatively. Before wound closure, patients were given intra-synovial injections of the following solutions: patients in group I received 40mL of 300mg ropivacaine with 1:200,000 epinephrine and 5mg morphine; patients in Group II received 40mL of 300mg ropivacaine with epinephrine; and patients in Group III received 50mL normal saline as a control. All patients received an epidural patient-controlled analgesia (PCA) for 24 postoperative hours. Analgesic efficacy was evaluated using the VAS at intervals of 2, 4, 6, 12, 24, 32, 40, and 48 hours postoperatively. During this period, the side effects, the dosage of rescue analgesia required, and the range of knee flexion were recorded for each group. RESULTS: There were no significant differences among the three groups with regards to the VAS and the required dose of rescue analgesia (p > 0.05). None of the groups demonstrated significant differences in the range of knee flexion and the incidence of postoperative nausea and emesis (p > 0.05). CONCLUSION: Therefore, we found that ropivacaine, alone or with morphine, injected into the synovial tissue, along with an epidural PCA has no additional benefits in pain control after a total knee arthroplasty.
Synovial Membrane ; Range of Motion, Articular ; Postoperative Complications/*prevention & control ; Pain, Postoperative/*drug therapy ; Osteoarthritis/surgery ; Morphine/administration & dosage/*therapeutic use ; Middle Aged ; Male ; Knee Prosthesis/*adverse effects ; Humans ; Female ; Double-Blind Method ; Arthritis, Rheumatoid/surgery ; Anesthetics, Local/administration & dosage/*therapeutic use ; Anesthesia, Epidural ; Analysis of Variance ; Analgesia ; Amides/administration & dosage/*therapeutic use ; Aged