Providing analgesia in the latent phase of labor can be challenging. Many obstetricians and nurse midwives believe that epidural analgesia initiated too early in the course of labor can prolong labor and result in fetal malpresentation, thus increasing the need for instrumentation. Many practitioners therefore use the combined spinal-epidural technique with intrathecal opioids during the early ...

Almost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia. CSE analgesia has gained worldwide acceptance and is becoming increasingly popular for labor pain relief. Obstetric anesthetists are divided when questioned on...

Intravenous opioids cause analgesia and increase release of ACh in spinal cord dorsal horn in animals, and these effects are enhanced by intrathecal neostigmine injection. The purpose of the current study was to test whether intrathecal neostigmine enhanced analgesia and increased cerebrospinal fluid concentrations of ACh over those induced by i.v. alfentanil in volunteers, and also to test whe...

The transversus abdominis plane (TAP) block is a field block that provides postoperative analgesia for abdominal surgery. Its analgesic utility after Caesarean delivery (CD) remains controversial. This systematic review and meta-analysis examines whether TAP block can reduce i.v. morphine consumption in the first 24 h after CD. The authors retrieved randomized controlled trials comparing TAP bl...

Pain is an essential sensory modality, signaling injury or threat of injury. Pain perception depends on both biological and psychological factors. However, it is not known whether psychological factors modify spinal mechanisms or if its effect is limited to cortical processing. Here, we use a placebo analgesic model to show that psychological factors affect human spinal nociceptive processes. M...

Almost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia. CSE analgesia has gained worldwide acceptance and is becoming increasingly popular for labor pain relief. Obstetric anesthetists are divided when questioned on...

We have performed a randomized comparison of two low-dose epidural regimens for analgesia in labour, differing only in the manner in which initial analgesia was established. In the epidural (EPI) group, 484 women received a loading dose of 20 ml of 0.1% bupivacaine with fentanyl 2 micrograms ml-1. In the combined spinal-epidural (CSE) group, 524 women received a spinal injection of plain bupiva...

BACKGROUND Despite epidural analgesia increasingly being utilized in hospitals, very little research-based evidence is available about registered nurses' (RNs) and midwives' knowledge of this technique. OBJECTIVE To describe the current epidural knowledge levels of RNs and midwives in a multi-site setting. METHOD RNs and midwives at four, regional teaching facilities completed an epidural k...

PURPOSE To investigate if early epidural analgesia can influence fetal head engagement into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. MATERIALS AND METHODS 195 women with combined spinal-epidural analgesia (CSE) or without neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 microg/ml of sufenta...