Database - (CIANE) | |
Description of this bibliographical database (CIANE website) |
https://ciane.net/id=225 | ➡ Modify this record |
Bibliographical entry (without author) : | Intrathecal opioids for combined spinal-epidural analgesia during labour. CNS Drugs. 2003;17(12):889-904. |
Author(s) : | DeBalli P, Breen TW. |
Year of publication : | 2003 |
URL(s) : | |
Résumé (français) : |
|
Abstract (English) : | In <25 years, intrathecal administration of opioids (i.e. spinal analgesia) has evolved from an experimental model into an important therapy for obstetric analgesia and anaesthesia. A small dose of opioid delivered into the CSF provides almost immediate relief from labour pain with minimal risks to the mother and fetus. Careful attention, and prompt treatment when needed, can ameliorate the adverse effects of fetal bradycardia, respiratory depression and pruritus. The major limitation of intrathecal opioids for labour analgesia is the short duration of effect: 90-180 minutes under ideal circumstances. To address this problem, and to increase flexibility for anaesthesia as well as analgesia, the combined spinal-epidural (CSE) technique was developed. The CSE technique involves injection of drugs into the CSF and placement of an epidural catheter. An intrathecally administered opioid provides a rapid onset of labour analgesia without motor block or significant haemodynamic perturbation. The epidural catheter allows ongoing administration of medications to maintain labour analgesia and provides a means of delivering anaesthesia for operative delivery. This review will focus on intrathecally administered opioids as used as part of CSE analgesia. Considerable research has focused on the optimum dose of opioids when delivered intrathecally, with or without adjuncts, in the CSE technique. Fentanyl and sufentanil, two of the lipophilic synthetic opioids, have emerged as the most useful. Bupivacaine, a long-acting local anaesthetic, is often added to prolong the duration of analgesia, although this tends to increase the likelihood of motor blockade of the lower extremities. Comparisons of the CSE technique with standard epidural practices have shown that both are effective means of providing analgesia during labour. Controversy revolves around the incidence of fetal bradycardia following CSE and whether this phenomenon increases the rate of operative deliveries. The rapid onset of analgesia with intrathecally administered opioids must be balanced against the added risks of dural puncture and considered in the context of the whole duration of labour. Ultimately, the decision to choose a CSE technique depends on the experience of the anaesthesia provider and the local availability of drugs, equipment and monitoring capabilities. |
Sumário (português) : |
|
Resumen (español) : |
|
Comments : | |
Argument (français) : |
|
Argument (English): | |
Argumento (português): |
|
Argumento (español): |
|
Keywords : | ➡ pain medication ; epidural ; pain |
Author of this record : | Cécile Loup — 15 Dec 2003 |
Discussion (display all languages) | ||
---|---|---|
New expert query --- New simple query
Creating new record --- Importing records
User management --- Dump database --- Contact
This database created by Alliance francophone pour l'accouchement respecté (AFAR) is managed
by Collectif interassociatif autour de la naissance (CIANE, https://ciane.net).
It is fed by the voluntary contributions of persons interested in the sharing of scientific data.
If you agree with this project, you can support us in several ways:
(1) contributing to this database if you have a minimum training in documentation
(2) or financially supporting CIANE (see below)
(3) or joining any society affiliated with CIANE.
➡ Sign in or create an account to follow changes or become an editor.
➡ Contact bibli(arobase)ciane.net for more information.
Donating to CIANE (click “Faire un don”) will help us to maintain and develop sites and public databases towards the support of parents and caregivers’ informed decisions with respect to childbirth |