By M. Joanne Douglas, Stephen H. Halpern
This can be the 1st textual content to systematically overview the proof for obstetric anesthesia and analgesia.
Evidence-based perform is now being embraced world wide as a demand for all clinicians; within the daily use of anesthesia and analgesia for childbirth, anesthetists will locate this synthesis of the easiest facts a useful source to notify their practice.
Contributions from anesthetic experts informed within the talents of systematic reviewing offer a complete and useful consultant to most sensible perform in basic and caesarean part childbirth.
This ebook, coming from one of many world’s prime obstetric facilities and the cradle of evidence-based medication, is a miles wanted addition to the obstetric anesthesia literature.
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Extra info for Evidence-Based Obstetric Anesthesia (Evidence-Based Medicine)
Blinding for the sham TENS group No sample size calculation 25/35 (TENS) vs 19/35 (sham) reported at least some pain relief. 2/35 (TENS) vs 0/35 (sham) reported worsening of pain Use of additional medication was similar Pain relief Additional medication Results Randomization by coin toss Concealed allocation (coin toss after consent) Sample size calculation ? Investigator blinded Description Outcome measures (main outcome if identiﬁed) Chapter 4 50% N2O 50% N2O 570 10 48 Electrodes placed bilaterally at T10–T11 and upper sacral Amplitude adjustment from 0 to 48 mA, burst mode, 50–200 Hz Electrodes placed bilaterally at T10–T11 and upper sacral Amplitude adjustment from 0 to 48 mA, burst mode 50–200 Hz 1 Not rated Randomized in concealed envelopes Not blinded No sample size calculation Quasi-randomization by order of admission Not blinded No sample size calculation Request for additional medication Pain intensity Request for additional medication Pain intensity No difference between groups Nulliparous patients for induction of labor only No difference between groups for any outcomes CSE, combined spinal epidural; IVPCA, intravenous patient-controlled analgesia; N2O, nitrous oxide; TENS, transcutaneous electrical nerve stimulation; VAS, visual analog score.
Patients in the highconcentration group were less likely to experience a spontaneous vaginal delivery than those who received a low concentration. Logistic regression showed that there was a statistically signiﬁcant increase in the incidence of obstetric intervention as the dose of bupivacaine (in milligrams) increased. Before and after studies In an attempt to avoid some of the problems encountered in randomized controlled trials, some investigators have studied institutions that had no epidural analgesia service for labor and then, over a brief period of time, introduced epidural analgesia into practice.
5–3 cm lateral to the spinous processes of the back to provide analgesia for the ﬁrst stage of labor. A second set of electrodes is placed over the S2–S4 dermatomes for the second stage of labor. Often a single machine has the capacity to activate all four electrodes simultaneously (“dual channel”). Less commonly, electrodes have been placed cranially or suprapubically. The amount of current can be changed by the woman as labor progresses, giving her a sense of control over the pain of labor. 2 While 30 TENS shares the advantages of other drugless therapies, there are some disadvantages to its use.