Miwako Saito

Subcutaneous sumatriptan for refractory trigeminal neuralgia.

Background.—Mechanical compression of the trigeminal root by an artery is thought to cause trigeminal neuralgia. The 5‐HT1B/1D receptor agonist may inhibit neurogenic inflammation and vasodilation near the irritated trigeminal root.

A double-blind randomized controlled trial of patient- controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

BACKGROUND Patient-controlled epidural analgesia (PCEA) combined with spinal analgesia is an option for pain relief in labor. However, the effect of a CBI on the analgesic requirements of laboring women is still debated. This double-blind study investigated the effect of CBI with PCEA following spinal analgesia on the local anesthetic requirements of parturients during labor. METHODS Sixty-six nulliparous women were randomly assigned to a standard PCEA protocol (5-mL demand bolus, 10-min lockout) with or without a CBI of 6 mL/h. The epidural solution consisted of 0.1% ropivacaine with fentanyl 2 microg/mL. Labor analgesia was initiated in both groups with intrathecal bupivacaine 2.5 mg plus fentanyl 25 microg. The number of demands per hour and the hourly dose of ropivacaine were calculated for both groups. RESULTS The median [range] number of analgesic boluses per hour in the PCEA group that were demanded: 2.4 [0.8-12.2] and delivered: 1.6 [0.8-2.6], were significantly greater than those in the PCEA+CBI group: 0.7 [0.4-4.2] and 0.6 [0.2-1.3] (P 0.05). However, the hourly ropivacaine dose in the PCEA group (7.9 [3.9-13.2] mg/h) was not significantly different from that in the PCEA+CBI group (8.4 [6.0-12.5] mg/h). CONCLUSION In laboring nulliparous patients provided initial labor analgesia with spinal anesthesia, the use of a continuous background infusion decreases PCEA demand dosing, but not the total hourly amount of ropivacaine and fentanyl used.

Patient-controlled epidural analgesia during labor using ropivacaine and fentanyl provides better maternal satisfaction with less local anesthetic requirement.

PurposeTo test the hypothesis that patient-controlled epidural analgesia (PCEA) using ropivacaine and fentanyl provides better maternal satisfaction and less anesthetic requirement than conventional continuous epidural infusion (CEI) during labor, we studied 58 uncomplicated parturients (singleton, vertex presentation).MethodsAfter establishing effective epidural analgesia with 11 ml of 0.2% ropivacaine, all parturients were randomly divided into one of two groups: the PCEA group (n = 29) or the CEI group (n = 29). In the PCEA group, the pump was initiated to deliver a basal infusion at 6 ml·h−1 and a demand dose of 5 ml; the lockout interval was 10 min, and there was a 31 ml·h−1 limit. The drugs used were 0.1% ropivacaine + fentanyl 2 µg·ml−1. In the CEI group, epidural analgesia was maintained with the same solution as the PCEA group at a constant rate of 10 ml·h−1. If parturients requested additional analgesia in the CEI group, we added 8 ml of epidural 0.2% ropivacaine without fentanyl.ResultsParturients’ demographic data, such as duration of labor, mode of delivery, Apgar score, and umbilical arterial pH did not differ between the two groups. However, the hourly requirement of ropivacaine was significantly less in the PCEA group than in the CEI group (9.3 ± 2.5 vs. 17.6 ± 7.6 mg·h−1; P < 0.05). Parturients’ satisfaction assessed by the Visual Analogue Scale tended to be higher in the PCEA group than in the CEI group. Side effects such as nausea, hypotension, and itching were similar for the two groups.ConclusionWe found that PCEA was an effective means of providing optimal analgesia, with better satisfaction during labor and less local anesthetic requirement.

Prophylactic epidural naloxone reduces the incidence and severity of neuraxial fentanyl-induced pruritus during labour analgesia in primiparous parturients.

1 ( 3%) 0 ( 0%) Hypotension (%) 4 (11%) 1 ( 3%) Nausea (%) 4 (11%) 3 ( 9%) Itching (%) * 25 (71%) 9 (26%) VAIS ** 20 (0, 72) 0 (0, 40) Fetal deceleration (n) 11 (31 %) 6 (18 %)

Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis.

This case report demonstrates the successful anesthetic management of cesarean section for a 29-year-old primiparous parturient with a past history of a scoliosis operation at 13 years of age. An Isola hook and screw-rod system had been implanted as posterior spinal instrumentation at the level of T3-L3. We titrated hyperbaric bupivacaine 7 mg combined with fentanyl 15 μg through a continuous spinal catheter, placed with a catheter-over-needle technique in order to avoid unintentional wide spread of anesthetic agents. The anesthetic level was T4 at the start of the operation. Her surgery was carried out without any problems. Headache, as a dural tap-related complication, was not observed. Spinal anesthesia with the titration of anesthetic agents for cesarean section is considered to be one of the choices for a parturient who has had spinal instrumentation.

Labour analgesia guided by echocardiography in a parturient with primary dilated cardiomyopathy

PurposeTo evaluate the effects of intrathecal analgesics on cardiac function during labour analgesia using echocardiography in a parturient with idiopathic dilated cardiomyopathy (DCM).Clinical featuresInduction of labour was planned in a 35-yr-old primiparous woman suffering from DCM. In order to stabilize hemodynamics in this patient, we induced continuous spinal analgesia with an infusion of fentanyl and epinephrine. Although her analgesia was well maintained for three hours during the first stage of labour, the patient complained of pain towards the second stage of labour. At this point, we administered bupivacaine intrathecally to alleviate her pain. Transthoracic echocardiography showed that the left ventricular end-diastolic and systolic dimensions, as well as the ejection fraction were not impaired by use of these analgesic medications.ConclusionMeasurement of left ventricular dimensions by echocardiography allowed us to monitor the patient’s response to intrathecal analgesic medications. In this patient with DCM, analgesia with intrathecal fentanyl and bupivacaine was well tolerated.RésuméObjectifÉvaluer les effets d’analgésiques intrathécaux sur la fonction cardiaque pendant le travail en utilisant l’échocardiographie chez une patiente qui présente une insuffisance cardiaque primitive (ICP).Éléments cliniquesL’induction du travail était planifiée chez une primipare de 35 ans souffrant d’ICP. Une rachianalgésie continue avec une perfusion de fentanyl et d’épinéphrine a été induite pour stabiliser l’hémodynamique. L’analgésie avait été bien maintenue pendant trois heures au cours de la première phase du travail, mais la patiente a eu des douleurs pendant la seconde phase. Nous avons donc donné de la bupivacaïne intrathécale. L’échocardiographie transthoracique a montré que les dimensions télédiastoliques et systoliques du ventricule gauche, de même que la fraction d’éjection, n’étaient pas atteintes par l’usage de ces analgésiques.ConclusionLa mesure des dimensions du ventricule gauche par échocardiographie a permis de vérifier la réaction à l’analgésique intrathécal. L’administration intrathécale de fentanyl et de bupivacaïne a été bien tolérée chez cette patiente atteinte d’ICP.