T. Kangas‐Saarela

Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine.

In a randomized study, the incidence of visceral pain was evaluated in 46 patients undergoing elective caesarean section under spinal or epidural anaesthesia with 0.5% bupivacaine. If the patient experienced pain during the operation, a standard visual analogue scale ranging from 0 to 10 was used to assess the degree of pain Visceral pain occurred in 12/23 patients in the spinal group and in 13/23 patients in the epidural group. In neither group was a correlation found between the cephalad level of analgesia or the intensity of cutaneous analgesia in the sacral region, and the presence of visceral pain.

The effects of epidural ropivacaine and bupivacaine for cesarean section on uteroplacental and fetal circulation.

Background Ropivacaine is a new long-acting amide local anesthetic that has been shown in animal studies to have less dysrhythmogenic and cardiotoxic potential than bupivacaine. The intravenous administration of ropivacaine has not been associated with any detrimental effects on uterine blood flow in pregnant ewes. The purpose of this randomized, double-blind study was to examine the effects of epidural ropivacaine for cesarean section on blood flow velocity waveforms in uteroplacental and fetal arteries with color Doppler ultrasound and to assess whether the block modified fetal myocardial function.

Parturients' assessment of water blocks, pethidine, nitrous oxide, paracervical and epidural blocks in labour

This prospective study evaluated the extent to which the analgesic procedures available resulted in efficient pain relief in 833 Finnish parturients. Their pain ratings were recorded according to their own assessment of pain intensity during labour before and after pain management and according to their total pain experience recalled on the third day after delivery. Only regional blocks significantly diminished pain scores during labour and a striking decrease in pain level (P < 0.0001) was maintained until the second stage by epidural analgesia (EDA) alone. The EDA-group consisted mainly of the primiparous (71%) with induced (17%) and most painful deliveries. After delivery 60% of parturients in this group recalled labour pain as being very severe or intolerable. This was partly due to delays in receiving epidural blockade and partly due to the parturients reticence in requesting analgesia. Pain relief was rated as excellent or good by 94% of the EDA group but by only 50% of the remaining patients.

Does ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section

The recovery of 16 infants born by elective caesarean section with spinal anaesthesia, in which either ephedrine or fluid load was used to prevent maternal hypotension, were studied using Scanlons neurobehavioural tests and a computerized EEG. Neurobehavioural testing showed no differences between the ephedrine and the non‐ephedrine groups of infants at ages of 3 h, 1 day, 2 days and 4–5 days, whereas the spectral EEG showed significant differences between the two groups during the first 2 h after delivery, which had disappeared 24 h later. It is suggested that small doses of ephedrine given to the mother i.v. to prevent hypotension during spinal anaesthesia have short‐lived effects on the neonates central nervous system, which will be detected in the spectral EEG, but not in neurobehavioural tests.

Paracervical Block-A Viable Alternative for Labor Pain Relief?

Background. Two hundred and forty‐eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injection technique were studied prospectively during the progress of labor in the three month study period. Parturients with signs of fetal distress were excluded. Pain level and the maternal, fetal and neonatal effects related to PCB were evaluated.

The effects of ephedrine and etilefrine on uterine and fetal blood flow and on fetal myocardial function during spinal anaesthesia for caesarean section

The effects of two vasopressors, ephedrine and etilefrine, on blood flow in maternal uterine, fetal umbilical, middle cerebral and renal arteries and on fetal myocardial function were studied by colour Doppler and M-mode echocardiography techniques during spinal anaesthesia for caesarean section. There were 7 healthy pregnant women in each treatment group. The vascular resistance of maternal uterine arteries increased significantly after both of the vasopressors while the vascular resistance of the umbilical artery remained unchanged. Ephedrine decreased the blood velocity waveform indices in the fetal middle cerebral and renal arteries, increased fetal right ventricular contractility and decreased left ventricular inner end-diastolic dimension. Fetal heart rate was unchanged. Etilefrine caused no detectable changes in fetal haemodynamics or in fetal myocardial function. These findings demonstrate that vasopressors administered for the treatment of minor maternal arterial pressure fall produce vasoconstriction in the uterine circulation during spinal anaesthesia, yet healthy fetuses seem to tolerate these haemodynamic alterations well. On the other hand, ephedrine caused changes in fetal myocardial function and in the vascular resistance of fetal middle cerebral and renal arteries, which demonstrates the potential modifying effect of vasoactive drug given to the mother on fetal haemodynamics.

The effect of segmental epidural analgesia on the neurobehavioural responses of newborn infants

The effects of maternal segmental epidural analgesia on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4–5 days. Subjects were healthy, term neonates born vaginally to 14 mothers with an epidural block and to 15 mothers without analgesia. The only statistically significant differences were found at the age of 1 day, when the epidural group infants habituated and oriented better to inanimate auditory stimuli. It is concluded that segmental epidural analgesia with a low dose of bupivacaine can be regarded as being a safe obstetric analgesic method as regards neonatal behavioural responses.

Postoperative Nausea and Vomiting After Sevoflurane With or Without Ondansetron Compared with Propofol in Female Patients Undergoing Breast Surgery

IMPLICATIONS: We studied 180 female patients undergoing breast surgery. The patients were randomly allocated to receive one of three anesthetic techniques. Compared with either propofol or sevoflurane alone, sevoflurane with ondansetron resulted in a decreased incidence of postoperative nausea and vomiting. Sevoflurane with ondansetron prophylaxis is a good alternative to propofol with respect to avoiding postoperative nausea and vomiting.

The effect of bupivacaine paracervical block on the neurobehavioural responses of newborn infants

The effects of maternal bupivacaine paracervical block on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4–5 days. Subjects were healthy, term neonates born vaginally to 10 mothers with paracervical block and to 12 mothers without analgesia. No statistically significant differences were found in the responses between the groups. It is concluded that paracervical block with a small dose of bupivacaine, applied by experienced obstetricians to non‐risk parturients with healthy foetuses, has no detrimental effects on newborn behaviour or neurological recovery.