Maternal and neonatal effects of adding morphine to low‑dose bupivacaine for epidural labor analgesia

Aim: Labor is one of the most painful experiences a woman may face during her lifetime. One of the most effective methods used for eliminating this pain is epidural analgesia. The aim of this study to determine the impact of adding morphine to low‑dose bupivacaine epidural anesthesia on labor and neonatal outcomes, and maternal side effects.Materials and Methods: This is a prospective randomized double‑blind study comparing two regimens of anesthetic agents used for epidural anesthesia in labor. A total of 120 pregnant women were randomized into two groups with 60 subjects in each study arm. A catheter was inserted, and 0.1% bupivacaine + 2 μg/mL fentanyl in 15 mL saline were given to Group bupivacaine‑fentanyl (Group BF), while 0.0625% bupivacaine + 2 μg/ml fentanyl + 2 mg morphine in 15 mL saline were given to Group bupivacaine‑fentanyl‑morphine (Group BFM) with no test dosing from the needle. No morphine was added to the subsequent epidural injections in Group BFM.Results: The total dose of bupivacaine was significantly lower in Group BFM relative to Group BF (P = 0.0001). The visual analogu scalescores at 15, 30, and 45 min were significantly lower in Group BF compared to thosein Group BFM (P = 0.0001, P = 0.001, and P = 0.006, respectively). The second stage of labor was significantly shorter in Group BFM relative to Group BF (P = 0.027 and P = 0.003, respectively). The satisfaction with analgesia following the first dose was higher in the nonmorphine group (P = 0.0001). However, maternal postpartum satisfaction was similar in both groups. Either nausea or vomiting was recorded in eight patients in Group BFM.Conclusion: We believe that epidural analgesia comprised of a low‑dose local anaesthetic and 2 mg morphine provides a painless labor that significantly reducesthe use of local anesthetic without changing the efficiency of the analgesic, ensuring the mother’s satisfaction without leading to an adverse effect on the mother or foetus, while mildly (but significantly) shortening the second stage of labor.Key words: Bupivacaine, epidural analgesia, fentanyl, morphine, painless labo

The effect of colloid preload versus prophylactic ephedrine administration on QTc intervals during cesarean delivery: A randomized controlled study

Aim: We aimed to investigate the effect of colloid infusion immediately before the spinal anesthesia, and the prophylactic intravenous (IV) infusion of ephedrine after injection of intrathecal bupivacaine on  hemodynamic parameters, QT, The QT interval corrected for heart rate (QTc), and dispersion of QTc (QTcDisp) intervals in women undergoing the elective cesarean section.Materials and Methods: Sixty women scheduled for elective cesarean delivery with spinal anesthesia were allocated randomly to receive either IV fluid preloading with 0.5 L of 6% w/v hydroxyethyl starch solution immediately before the spinal anesthesia (colloid group, n = 30) or prophylactic IV infusion of 15 mg ephedrine (diluted with 10 ml saline, n = 30) over 1.min period after the injection of intrathecal  bupivacaine (ephedrine group). Electrocardiography (ECG) tracings were recorded before anesthesia procedure at baseline (T0), 5 min (T1), 10 min (T2), 30 min (T3), 60 min (T4), and 120 min (T5) after the spinal anesthesia. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were also recorded at the same time  intervals.Results: There were no significant differences between groups with respect to MAP, HR, SpO2, QT, and QTc intervals at any time points (P > 0.05). When compared with the colloid group, the QTcDisp interval at To1 was significantly longer in the ephedrine group (P < 0.05).Conclusion: Both methods have similar effects on the ECG and hemodynamic parameters during  cesarean section. So, both methods may be used in patients undergoing elective cesarean delivery under spinal anesthesia. Key words: Anesthesia, cesarean section, colloid, electrocardiography, ephedrine, spina

The effect of intravenous preemptive paracetamol on postoperative fentanyl consumption in patients undergoing open nephrectomy: A prospective randomized study

Conclusion: In patients undergoing open nephrectomy, use of preemptive or postoperative paracetamol reduces fentanyl related nausea-vomiting without a decrease in total fentanyl consumption in the early postoperative period. Furthermore, use of preemptive or postoperative paracetamol reduces total fentanyl requirements in the first 24 h postoperatively providing a safe and effective postoperative analgesia