No abstract available.
Analgesia, Obstetrical*

Analgesia, Patient-Controlled* ; Anesthesia, Obstetrical*

Parturients with both ankylosing spondylitis (AS) and SARS-CoV-2 Infection (COVID-19) present unique challenges to anesthesiologists. Neuraxial analgesia for labor remains the gold standard in obstetric patients. However, in patients with AS, this approach may be deemed difficult to impossible. Administration of systemic opioids for labor analgesia can be an option, bearing in mind the potential respiratory depressant effect to both the mother and the fetus, especially in the setting of concomitant COVID-19. This paper reports the successful management of such a patient using patient-controlled analgesia (PCA) with intravenous remifentanil.
Spondylitis, Ankylosing ; Remifentanil ; Analgesia, Patient-Controlled ; Analgesia, Obstetrical ; COVID-19

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

Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patient-controlled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.
Analgesia* ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthetics, Local ; Humans ; Methods ; Pain Management ; Punctures ; Ultrasonography

OBJECTIVETo observe analgesic effect of scalp acupuncture on labor.

METHODSSeventy primiparae with term pregnancy and monocyesis were randomly divided into scalp acupuncture group treated by acupuncture at the Shengzhi area of scalp, and control group by no treatment. Pain grades before and after scalp acupuncture were evaluated with the pain 4-grade rating criteria stipulated by WHO, and the active stage and the second birth process, the Apgar scores of new-born and postpartum hemorrage amount were compared between the two groups.

RESULTSThe labor pain with 1 to approximately 2 grades was found in 33 cases in the scalp acupuncture group, and 2 cases in the control group with very significant difference between the two groups (P < 0.01); the active stage was (130.70 +/- 74.16 ) min and the second birth process was (40.70 +/- 21.65) min in the scalp acupuncture group, and (166.15 +/- 62.65) min and (53.30 +/- 26.93) min in the control group, respectively, with significant differences between the two groups (all P < 0.05); and there were no significant differences in Apgar score of new-born and postpartum hemorrhage amount.

CONCLUSIONScalp acupuncture has a better analgesic effect in vaginal delivery with no adverse effect on the mother and infant.

Acupuncture Analgesia ; Adult ; Analgesia, Obstetrical ; Apgar Score ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Scalp

OBJECTIVE: To observe effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia and explore its possible mechanism. METHODS: A total of 160 primipara were randomly divided into an observation group (80 cases, 12 cases dropped off ) and a control group (80 cases, 15 cases dropped off ). The primipara in the control group received epidural labor analgesia. In the observation group, 15 min after epidural labor analgesia was performed, magnetic beads auricular point sticking therapy was given at shenmen (TF RESULTS: There was no significant difference in tympanic temperature in the observation group at each time point ( CONCLUSION Magnetic beads auricular point sticking therapy can reduce the amount of anesthetics, decrease the effect of epidural analgesia on primipara's body temperature regulation and labor progress, and lower the incidence of fever during labor analgesia by regulating the level of inflammatory response in the primipara.
Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesics ; Cesarean Section ; Female ; Humans ; Labor, Obstetric ; Magnetic Phenomena ; Pregnancy

BACKGROUNDThe palpation method is widely used in clinical practice to identify the puncture site of combined spinal-epidural (CSE) blocks, but it is usually difficult to accurately locate the puncture site in obese parturients. Accurate identification of the puncture site is crucial for successful CSE block. The objective of this study was to evaluate the impact of ultrasound imaging on the success rate of CSE puncture in obese parturients.

METHODSSixty obese parturients with a body mass index ≥ 30 kg/m(2) who were scheduled for caesarean section were randomized into two equal-sized groups for location of the puncture site: an ultrasound group and a palpation group. The success rate of puncture at the first puncture site, the number of puncture attempts, duration of CSE procedure, time taken to determine the puncture site, and the depth of the epidural space were compared between groups. The frequencies of complications such as puncture site hemorrhage, neurological damage, and inadvertent dural puncture were also studied.

RESULTSThere were no differences in age, body weight, height, body mass index, or gestational age between the two groups. The success rate of puncture at the first puncture site was significantly higher in the ultrasound group than the palpation group (100.00% vs. 70.00%, P = 0.004). The number of puncture attempts was significantly lower in the ultrasound group than the palpation group (χ(2) = 6.708, P = 0.035). The time taken for determining the puncture site was (0.30 ± 0.12) minutes in the palpation group and (2.60 ± 0.61) minutes in the ultrasound group (P < 0.001). The duration of CSE procedure was (7.67 ± 1.52) minutes in the palpation group and (9.37 ± 1.35) minutes in the ultrasound group (P < 0.001). The depth of the epidural space was similar in both groups (P = 0.586). Puncture site hemorrhage was observed in 6 (20.00%) patients in the palpation group and 2 (6.67%) patients in the ultrasound group (P = 0.255).

CONCLUSIONSUltrasound imaging improves the rate of successful puncture at the first puncture site and decreases the number of puncture attempts. It facilitates CSE puncture in obese parturients.

Adult ; Analgesia, Epidural ; methods ; Analgesia, Obstetrical ; methods ; Female ; Humans ; Obesity ; complications ; Pregnancy ; Spinal Puncture ; methods ; Ultrasonography, Interventional

OBJECTIVE: To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia (CSEA) and patient-controlled epidural analgesia (PCEA) for labor analgesia. METHODS: A total of 307 participants were prospectively collected from July 2017 to December 2019. The participants were randomized into the combined acupoint injection with CSEA plus PCEA group (AICP group, n=168) and CSEA plus PCEA group (CP group, n=139) for labor analgesia using a random number table. Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process, and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli (ST 36) and Sanyinjiao (SP 6) were selected in addition. The primary outcome was Visual Analogue Scale (VAS) score, and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses. Safety evaluations were performed after intervention. RESULTS: The VAS scores were significantly lower in the AICP group than in the CP group at 10, 30, 60, and 120 min after labor analgesia (all P<0.05). The latent phase of the AICP group was shorter than that of the CP group (P<0.05). There were less additional anesthetics consumption, lower incidences of uterine atony, fever, pruritus and urinary retention in the AICP group than those in the CP group (all P<0.05). CONCLUSION Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption, improve analgesic quality, and reduce adverse reactions in the parturients. (Registration No. ChiMCTR-2000003120).
Acupuncture Points ; Analgesia, Obstetrical/adverse effects* ; Analgesia, Patient-Controlled/adverse effects* ; Anesthetics/pharmacology* ; Female ; Humans ; Labor, Obstetric ; Pregnancy

Epidural clonidine produces analgesia via non-opioid mechanism and it may be used as an adju-vant to local anesthetics in obstetric analgesia. To evaluate the effects of epidural clonidine and bupivacaine for post-cesarean section analgesia, we designed a double-blind study. Sixty patients scheduled for elective cesarean section were divided into three groups. Group 1 (n=20) received 0.125% bupivacaine 2 ml/hour epidurally for 2 days. Group 2 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 10 ug/hour for 2 days. Group 3 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 20 ug/hour for 2 days. At the end of the cesarean section, above drug was administered epidurally. Postoperative analgesia was assessed by recording VAS(visual analogue scales) at 1, 2, 4, 8, 16, 32 and 48 postoperative hours. Sedation score, heart rate and systolic and diastolic blood pressure were also checked. The results were as follows: 1) VAS were significantly decreased in group 2 at 1~16 hours and in group 3 at 1~32 hours compared with group 1, They were decreased in group 3 compared with group 2 at 1~48 hours but no significance was seen between two groups. 2) The changes of systolic and diastolic blood pressures & sedation scores were not significantly different between any two groups. In summary, co-administration of clonidine and bupivacaine epidurally provided more profound analgesia compared with bupivacaine alone after cesarean section.
Analgesia ; Analgesia, Epidural ; Analgesia, Obstetrical ; Anesthetics, Local ; Blood Pressure ; Bupivacaine* ; Cesarean Section* ; Clonidine* ; Double-Blind Method ; Female ; Heart Rate ; Humans ; Pregnancy