Pro-con debate: low dose CSE is the technique of choice for anesthesia for elective C-section

status: publishe

Editorial. Remifentanil PCIA for labour analgesia: a world of caution

status: publishe

Initiation of neuraxial labour analgesia

edition: 1ststatus: publishe

Postdural Puncture Headache (PDPH)

Postdural puncture headache (PDPH) is probably the most common complication following neuraxial anesthesia or analgesia in the obstetric patient. Intentional puncture of the dura (by way of a spinal needle) or inadvertent dural puncture (by epidural needle or catheter) can cause a temporary leak of CSF and produce a typical headache pattern. In this text we will specifically discuss accidental dural puncture and PDPH following epidural anesthesia.nrpages: 101-108status: publishe

Unplanned cesarean section in women with a labor epidural catheter in situ: the role of chloroprocaine 3% - a narrative review

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Perimortem caesarean section for cardiac arrest resuscitation in peripartum: a literature review

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Programmed intermittent epidural boluses versus patient controlled epidural analgesia without background infusion for labour analgesia: effects on local anaesthetic consumption and maternal motor function: a randomized, double-blind study in nulliparous women

edition: Abstracts of Free Papers Presented at the Annual Meeting of the Obstetric Anaesthetists' Associationstatus: publishe

Breakthrough pain during cesarean section under neuraxial anesthesia : a two-center prospective audit

Worldwide, most Cesarean sections (CS) are performed under neuraxial anesthesia. However, neuraxial anesthesia can fail and intraoperative breakthrough pain can occur. The aim of the present investigation was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two center, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy. A total of 393 patients were enrolled in the study over 6 months, 206 in UZ Leuven and 187 in ZNA Middelheim, 295 elective CS and 98 secondary CS. Of all 393 participants, 65 experienced breakthrough pain during the CS (16.5%). Twoo significant risk factors for breakthrough pain during CS were observed: the duration of surgery (p < 0.001) and the epidural drug used (p=0.0032). Breakthrough pain during a CS is extremely uncomfortable for the mother. In this observational study, the incidence of breakthrough pain during CS was 16.5%.uration of surgery and epidural drug used were both significant risk factors of breakthrough pain during CS in this audit. A pro-active policy is required in order to prevent breakthrough pain or discomfort during CS. Early identification of problematic epidural catheters for labor analgesia, adequate level of anesthetic block before surgery, and administration of a prophylactic epidural top-up if duration of surgery is prolonged as opposed to the choice of local anesthetic used, could be essential in the prevention. Further high-quality studies are needed to evaluate the many potential risk factors associated with breakthrough pain during CS

A double-blind randomized controlled trial comparing dexamethasone and clonidine as adjuvants to a ropivacaine sciatic popliteal block for foot surgery

BACKGROUND AND AIMS: A popliteal block is effective in managing postoperative pain for foot surgery, but since the duration of analgesia is limited following a single-shot popliteal fossa block technique, methods to prolong effective postoperative analgesia are mandatory. The aim of this study was to assess the effect of adjuvants to ropivacaine on the duration of sensory and motor block. METHODS: In this double-blind randomized placebo-controlled study, we evaluated the analgesic effect of clonidine or dexamethasone (DXM) when added to ropivacaine for hallux valgus surgery. After obtaining institutional ethics research board approval and written informed consent, a total of 72 patients were randomly allocated. Fifty-seven of these patients were statistically analyzed. All patients received an ultrasound-guided single-shot popliteal fossa block with 30 mL of ropivacaine 0.75%, supplemented with saline, clonidine 100 µg, or DXM 5 mg. The primary end point was time to first pain sensation. Secondary end points were time to complete sensory and motor block regression. RESULTS: Compared to saline, duration to first pain sensation was prolonged by 9 hours (mean ± standard deviation: 31±9 hours) (42%) in the DXM group (P=0.024) and by 6 hours (28±10 hours) (27%) in the clonidine group (P=0.024). Compared to saline, DXM prolonged both complete sensory and motor blockade by 12 hours (25±7 hours) (46%) and 13 hours (36±6 hours) (55%), respectively, while clonidine prolonged complete sensory and motor blockade by 7 hours (30±7 hours) (27%) and 2 hours (22±5 hours) (10%), respectively. DXM prolonged sensory block regression time by 6 hours (21±7 hours) (41%) and clonidine by 2 hours (17±6 hours) (13%) compared to the control group (P=0.006). Similarly, DXM prolonged motor block regression by 7 hours (25±7 hours) (46%) and clonidine by 4 hours (21±4 hours) (19%) (P<0.0001). CONCLUSION: Addition of DXM and clonidine to ropivacaine significantly prolonged the duration of postoperative sensory and motor block