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Germeshausen K, Linzbach A, Zöllkau J, Heimann Y, Schleussner E, Groten T, Weschenfelder F. SPAM-sub partual analgesia with meptazinol: a prospective cohort study comparing intramuscular with intravenous administration. Arch Gynecol Obstet 2024; 309:1873-1881. [PMID: 37160471 PMCID: PMC11018690 DOI: 10.1007/s00404-023-07056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction. METHODS 132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann-Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed). RESULTS Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8-10) to 6 (IQR 4.75-8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195. CONCLUSION Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.
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Affiliation(s)
| | - Aissa Linzbach
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Mammadov B, Taş Ç. The effect of acupressure and massage on labor pain and birth satisfaction: a randomized controlled trial. Explore (NY) 2024:S1550-8307(24)00082-X. [PMID: 38693027 DOI: 10.1016/j.explore.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/20/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This randomized controlled trial was conducted to determine the effect of acupressure and massage used for the management of labor pain in the latent, active, and transition phases of the first stage of labor on labor pain and birth satisfaction. METHODS The study was conducted with 66 pregnant women who met the sampling criteria and participated voluntarily at a public hospital in Nicosia. The participants were randomly assigned to one of three groups: a massage group, an acupressure group, or a control group. Participants in the massage group received 10 min of sacral massage during contraction and 10 min of endorphin massage during rest, for a total of 30 min of massage per phase. Participants in the acupressure group received 3 min of acupressure to the LI 4 point at the same dilation intervals, when the contraction was most intense. The control group received no intervention. Pain perceived by the pregnant woman was evaluated with the Visual Comparison Scale (VAS) at the beginning and end of each phase. Postpartum, the Birth Satisfaction Scale was applied. RESULTS Massage application was found to be more effective in reducing labor pain than acupressure or the control group. Massage and acupressure did not negatively affect APGAR scores. The lowest oxytocin use was found in the massage group. The group with the highest birth satisfaction scores was also the massage group. CONCLUSION Massage application is more effective than acupressure application in reducing labor pain and increasing birth satisfaction.
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Affiliation(s)
- Betül Mammadov
- RN, PhD, Assistant Professor, Near East University, Faculty of Health Sciences, Near East Boulevard, 99138 Nicosia, Cyprus.
| | - Çağla Taş
- M. Sc. Midwife, Cengiz Topel Hospital, Ecevit Caddesi, Güzelyurt, 99300 Girne, Cyprus
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Masroor P, Mehrabi E, Nourizadeh R, Pourfathi H, Asghari-Jafarabadi M. The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial. BMC Pregnancy Childbirth 2024; 24:305. [PMID: 38654255 PMCID: PMC11040826 DOI: 10.1186/s12884-024-06270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/12/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression. MATERIALS AND METHOD This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention. RESULTS The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01). TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022. CONCLUSION The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.
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Affiliation(s)
- Parinaz Masroor
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmat Mehrabi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Roghaiyeh Nourizadeh
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojjat Pourfathi
- Department of Anesthesiology and Pain Management, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Shebelsky R, Sadi W, Heesen P, Aber RN, Fein S, Iluz-Freundlich D, Shmueli A, Azem K, Radyan Tamayev I, Binyamin Y, Orbach-Zinger S. The relationship between postpartum pain and mother-infant bonding: A prospective observational study. Anaesth Crit Care Pain Med 2024; 43:101315. [PMID: 37865216 DOI: 10.1016/j.accpm.2023.101315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Postpartum pain is associated with impaired maternal recovery and may influence mother-infant bonding. METHODS Participants who underwent a vaginal or cesarean delivery were assessed 24 h postpartum. Postpartum pain intensity was measured using the Verbal Numeric Score (VNS) (0-10) and classified as non-severe (<8) or severe pain (≥8). Maternal-infant bonding was evaluated using the Post-Partum Bonding Questionnaire (PBQ; 0-125), with a score > 5 defining impaired bonding. Demographic data included age, BMI, parity, education level, economic status, partnership, prior history of depression, familial history of depression, desire to breastfeed, epidural analgesia during labor, rooming in, and Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed using 2 separate multivariable logistic regression models for vaginal and cesarean deliveries, where maximum postpartum pain was the independent variable and impaired postpartum bonding was the dependent variable and controlled for the other factors collected. RESULTS Severe postpartum pain (VNS ≥ 8) showed no significant relationship with impaired bonding when controlling for confounding variables. In vaginal deliveries, there was an association between a history of depression and impaired bonding (Odds Ratio 2.2 [1.07-4.65], p = 0.04) and EPDS > 10 and impaired bonding (OR 11.5 [3.2-73.6], p < 0.001). For cesarean deliveries, rooming in with the baby had a protective effect (OR 11.5 [3.2-73.6], p < 0.001). CONCLUSIONS Contrary to expectations, severe postpartum pain did not influence maternal-infant binding in the cohort of patients with vaginal and cesarean deliveries. Instead, factors such as maternal mental health and rooming-in practices appeared to exert more significant influence. CLINICAL TRIAL REGISTRATION NCT05206552.
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Affiliation(s)
- Rostislav Shebelsky
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Wadeea Sadi
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | | | - Rachel N Aber
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shai Fein
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Iluz-Freundlich
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Radyan Tamayev
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Sharon Orbach-Zinger
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Elgzar WT, Alshahrani MS, Ibrahim HA. Non-pharmacological labor pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia. Reprod Health 2024; 21:11. [PMID: 38268021 PMCID: PMC10809473 DOI: 10.1186/s12978-023-01737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Traditionally, pharmacological pain relief methods have been the most acceptable option for controlling labor pain, accompanied by numerous adverse consequences. Non-pharmacological labor pain relive methods can reduce labor pain while maintaining an effective and satisfying delivery experience and delaying the use of pharmacological methods. This study explores the utilization of non-pharmacological labor pain relive methods and its associated factors among midwives and maternity nurses. METHODS A cross-sectional research was conducted in Maternal and Children Hospital/Najran, Saudi Arabia, from April to May 2023 and incorporated a convenience sample of 164 midwives and maternity nurses. The data was collected using a self-reported questionnaire composed of five sections; basic data, facility-related factors, non-pharmacological labor pain relive utilization and attitude scales, and knowledge quiz. A logistic regression was used to determine the associated factors with non-pharmacological labor pain relive utilization. RESULTS The results revealed that 68.3% of participants utilized non-pharmacological labor pain relive methods. The midwives and maternity nurses helped the parturient to tolerate labor pain by applying the non-pharmacological labor pain relive methods, including; positioning (55.5%), breathing exercises (53.7%), comfortable and relaxing environment (52.4%), therapeutic communication (47%), positive reinforcement (40.9%), relaxation (40.2%), and therapeutic touch (31%). In addition, working unit, providers-patient ratio, working hours, non-pharmacological labor pain relive training, years of experience, and non-pharmacological labor pain relive attitude were significant determinants of non-pharmacological labor pain relive utilization (P < 0.05). CONCLUSIONS High non-pharmacological labor pain relive utilization was significantly associated with nurses' older age and higher education, working in the delivery room, lower nurse-patient ratio, lower working hours, in-services training, increased years of experience, and positive attitude. The study sheds light on the importance of handling the pre-mentioned factors to enhance non-pharmacological labor pain relive utilization.
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Affiliation(s)
- Wafaa T Elgzar
- Department of Maternity and Childhood Nursing, Nursing College Najran University, Najran, Kingdom of Saudi Arabia
| | - Majed S Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Heba A Ibrahim
- Department of Maternity and Childhood Nursing, Nursing College Najran University, Najran, Kingdom of Saudi Arabia.
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Lin W, Lin J, Yang Y, Lin L, Lin Q. Dural puncture epidural with 25-G spinal needles versus conventional epidural technique for labor analgesia: A systematic review of randomized controlled trials. Technol Health Care 2024; 32:495-510. [PMID: 37545267 DOI: 10.3233/thc-230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Dural mater is punctured by using a spinal needle without drugs administrated into intrathecal space directly in dural puncture epidural (DPE) analgesia. OBJECTIVE This study aimed to summarize the evidence of benefits and risks of DPE analgesia with 25-G spinal needles for labor pain relief. METHODS DPE analgesia with EP analgesia for labor pain relief were systematically searched. The Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science databases were systematically searched till 6th November 2022 to find out randomized controlled trials (RCTs) comparing DPE (using 25-G spinal needles) with conventional epidural (EP) analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio, mean difference, and 95% confidence intervals were calculated. RESULTS Seven RCTs with 761 parturients were identified. Pool data showed that DPE technique was associated with shorter time to pain score ⩽ 3/10, higher percentage with pain score ⩽ 3/10 at 10 min and 20 min, lower incidence of epidural top-up bolus and no S2 block, higher incidence of bilateral S2 blockade at 10 min and during labor, lower incidence of epidural top-up bolus and incidence of asymmetric block. No statistical difference in side effect and parturient satisfaction between DPE and EP technique. CONCLUSION DPE technique with 25-G spinal needles was associated with faster analgesia onset and sacral coverage, greater sacral spread, lesser requirement of epidural top-up and lower incidence of asymmetric block. DPE technique with 25-G spinal needles showed a greater benefit to parturients.
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Affiliation(s)
- Wenqian Lin
- Department of Anesthesiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Anesthesiology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Lin
- Department of Anesthesiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Anesthesiology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yongyong Yang
- Department of Anesthesiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Anesthesiology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Lianhe Lin
- Department of Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Qun Lin
- Department of Anesthesiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Anesthesiology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
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Kaya A, Yeşildere Sağlam H, Karadağ E, Gürsoy E. The effectiveness of aromatherapy in the management of labor pain: A meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100255. [PMID: 37954534 PMCID: PMC10632671 DOI: 10.1016/j.eurox.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
One non-pharmacological method that can be used to safely and without negative side effects is aromatherapy. This meta-analysis study was carried out to assess the effectiveness of aromatherapy in the treatment of labor pain. The analysis included 14 randomized controlled trials of aromatherapy interventions for labor pain. In the studies, it was observed that aromatherapy was applied through massage and inhalation using oils such as lavender, jasmine, rose, chamomile, bitter orange, and boswellia. In the meta-analysis, it was discovered that aromatherapy had a beneficial effect on the management of labor pain and reduced labor pain in the intervention group in 11 studies; it was found that there was no effect in 3 studies. According to analysis findings, aromatherapy significantly lessened the intensity of labor pain. The study's findings support the notion that aromatherapy can lessen labor pain.
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Affiliation(s)
- Atike Kaya
- Eskisehir Osmangazi University, Health Sciences Institute, Department of Nursing, Eskisehir, Turkey
| | - Havva Yeşildere Sağlam
- Kütahya Health Sciences University, Faculty of Health Sciences, Department of Nursing, Kütahya, Turkey
| | - Engin Karadağ
- Akdeniz University, Faculty of Education, Department of Educational Sciences, Antalya, Turkey
| | - Elif Gürsoy
- Eskisehir Osmangazi University, Faculty of Health Sciences, Department of Nursing, Eskisehir, Turkey
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Ni F, Wu Z, Zhao P. Programmed intermittent epidural bolus in maintenance of epidural labor analgesia: a literature review. J Anesth 2023; 37:945-960. [PMID: 37733073 DOI: 10.1007/s00540-023-03253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Programmed intermittent epidural bolus (PIEB), administered by the infusion pump programmed to deliver boluses of epidural solution at certain intervals, is gradually gaining more attention as a technique to maintain the labor analgesia in recent years. Many studies find that it may have some advantages when compared with other methods. However, its exact effectiveness and optimal regimen are still unclear. We conducted a literature search in PubMed, Web of Science, and Cochrane Database of Systematic Reviews for studies published between January 2010 and June 2022. Of the 263 publications identified, 27 studies were included. The purpose of this review is to discuss the effects of PIEB with continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) in maintenance of epidural labor analgesia on labor outcomes and elucidate the latest research progress of implementation strategies.
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Affiliation(s)
- Fanshu Ni
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street Heping District, Shenyang, CN 110004, Liaoning Province, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street Heping District, Shenyang, CN 110004, Liaoning Province, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street Heping District, Shenyang, CN 110004, Liaoning Province, China.
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Chang XY, Wang LZ, Xia F, Zhang YF. Factors associated with epidural-related maternal fever in low-risk term women: a systematic review. Int J Obstet Anesth 2023; 56:103915. [PMID: 37625990 DOI: 10.1016/j.ijoa.2023.103915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/22/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The underlying mechanism of epidural-related maternal fever (ERMF) is not fully understood. This systematic review aimed to identify factors associated with ERMF in low-risk, full-term women using neuraxial analgesia. METHODS PubMed, Embase, Web of Science, CENTRAL, and Wanfang Data were searched from inception to September 10, 2022 with no language restriction. Studies reported descriptive data regarding the factors associated with ERMF. A random effects model meta-analysis was used to pool the raw data of univariate analyses for each identified factor. Sensitivity and subgroup analyses were performed to explore possible sources of heterogeneity. RESULTS Eighteen observational studies involving 33 427 women were included, with 18 factors eligible for meta-analyses. Higher body mass index, baseline temperature, admission maternal interleukin-6 levels and white blood cell counts, nulliparity, increasing gestational age, longer duration of labor and rupture of membranes, increasing number of vaginal examinations, oxytocin use, higher birth weight, lower cervical dilation at initiation of analgesia, and longer analgesia duration were associated with increased risk of ERMF, while intermittent compared with continuous epidural dosing was associated with a decreased risk of ERMF (odds ratio 0.25, 95% CI 0.16 to 0.48, P < 0.001). However, heterogeneity among studies was high and the quality of evidence was low for these meta-analyses, except for intermittent epidural dosing. CONCLUSIONS Many factors are associated with ERMF but may not be independent or causal. Further study is needed to clarify the interactions of these factors in ERMF development and whether modification of these factors might influence risk of ERMF.
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Affiliation(s)
- X Y Chang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - L Z Wang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| | - F Xia
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Y F Zhang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
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Tan CW, Tan NYK, Sultana R, Tan HS, Sng BL. Investigating the association factors of acute postpartum pain: a cohort study. BMC Anesthesiol 2023; 23:252. [PMID: 37491196 PMCID: PMC10367238 DOI: 10.1186/s12871-023-02214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Labor pain intensity is known to predict persistent postpartum pain, whereas acute postpartum pain may interfere with maternal postpartum physical, mental, and emotional well-being. Nevertheless, there is little research studying the association between labor pain intensity and acute postpartum pain. This study investigated the associations between labor pain intensity and psychological factors with acute postpartum pain. METHODS We included women with American Society of Anesthesiologists (ASA) physical status II, having ≥ 36 gestational weeks and a singleton pregnancy. We investigated the association between labor pain intensity (primary exposure) and high acute postpartum pain at 0 to 24 h after delivery (Numeric Rating Scale (NRS) ≥ 3 of 10; primary outcome). Pre-delivery questionnaires including Angle Labor Pain Questionnaire (A-LPQ), Pain Catastrophizing Scale (PCS), Fear Avoidance Components Scale (FACS) and State Trait Anxiety Inventory (STAI) were administered. Demographic, pain, obstetric and neonatal characteristics were also collected accordingly. RESULTS Of the 880 women studied, 121 (13.8%) had high acute postpartum pain at 0 to 24 h after delivery. A-LPQ total, PCS, FACS and STAI scores were not significantly associated with acute postpartum pain. Greater A-LPQ subscale on birthing pain (adjusted odds ratio (aOR) 1.03, 95% CI 1.01-1.05, p = 0.0008), increased blood loss during delivery (for every 10ml change; aOR 1.01, 95% CI 1.00-1.03, p = 0.0148), presence of shoulder dystocia (aOR 10.06, 95% CI 2.28-44.36, p = 0.0023), and use of pethidine for labor analgesia (aOR 1.74, 95% CI 1.07-2.84, p = 0.0271) were independently associated with high acute postpartum pain. "Sometimes" having nausea during menstruation before current pregnancy (aOR 0.34, 95% CI 0.16-0.72, p = 0.0045) was found to be independently associated with reduced risk of high acute postpartum pain. CONCLUSIONS Pre-delivery pain factor together with obstetric complications (shoulder dystocia, blood loss during delivery) were independently associated with high acute postpartum pain. TRIAL REGISTRATION This study was registered on clinicaltrials.gov registry (NCT03167905) on 30/05/2017.
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Affiliation(s)
- Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | | | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore.
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, Singapore.
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An SY, Park EJ, Moon YR, Lee BY, Lee E, Kim DY, Jeong SH, Kim JK. The effects of music therapy on labor pain, childbirth experience, and self-esteem during epidural labor analgesia in primiparas: a non-randomized experimental study. Korean J Women Health Nurs 2023; 29:137-145. [PMID: 37415482 DOI: 10.4069/kjwhn.2023.06.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE This non-randomized study was performed to evaluate the effects of music therapy on labor pain, the childbirth experience, and self-esteem in women during vaginal delivery. METHODS In total, 136 primiparous women over 37 weeks of gestation receiving epidural analgesia during vaginal delivery were recruited via convenience sampling. To minimize diffusion effects, data from the control group (n=71) were collected first (April 2020 to March 2021), followed by data from the music group (n=65; April 2021 to May 2022). Participants in the music group listened to classical music during labor, while the control group was offered usual care (no music). Labor pain was measured using a numeric rating scale (NRS), and self-esteem and childbirth experience were collected using self-report questionnaires. Data were analyzed using the independent t-test, chi-square test and Cronbach's α coefficients. RESULTS The overall pain level (NRS) at baseline was 0 in both groups. Mothers in the music therapy group had lower levels of latent pain (t=1.95, p=.005), active pain (t=3.69, p<.001) and transition-phase pain (t=7.07, p<.001) than the control group. A significant difference was observed between the two groups, and the music therapy group expressed more positive perceptions of the childbirth experience (t=-1.36, p=.018). For self-esteem, the experimental group's score was slightly higher, but without a statistically significant difference from the control group. CONCLUSION Using music therapy during labor decreased labor pain and improved the childbirth experience. Music therapy can be clinically recommended as a non-pharmacological, safe, and easy method for nursing care in labor. Clinical trail number: KCT008561.
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Affiliation(s)
- Seong Yeon An
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Eun Ji Park
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yu Ri Moon
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Bo Young Lee
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Eunbyul Lee
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dong Yeon Kim
- Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seong Hee Jeong
- Delivery Room, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jin Kyung Kim
- Obstetrics Ward, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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Dastjerd F, Erfanian Arghavanian F, Sazegarnia A, Akhlaghi F, Esmaily H, Kordi M. Effect of infrared belt and hot water bag on labor pain intensity among primiparous: a randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:405. [PMID: 37264341 DOI: 10.1186/s12884-023-05689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Labor pain is complex, paradoxical and varied in every parturient woman. Management of labor pain has been a crucial component in maternity care. Heat therapy is one of the proposed method for labor pain relief. Infrared is one of the methods of heat therapy but there is any study in this regard. This study aimed to compare the effect of the infrared belt and hot water bag on the severity of pain in the first stage of labor among primiparous women. METHODS In this clinical trial in the first stage of labor, 20-min cycles of heat therapy were conducted at the dilations of 4-5 and 6-7 cm in the intervention group 1 by an infrared belt and in the intervention group 2 by hot water bag, respectively. The control group received routine care. The severity of the pain was measured by the short-form McGill Pain Questionnaire. RESULTS In total, 136 women consented to participate in this clinical trial study. The mean score of pain intensity was significantly lower in the two intervention groups compared to the control group (P < 0.001). The mean pain intensity was significantly lower in the infrared belt group than in the hot water bag group (P < 0.001). CONCLUSIONS Based on these findings, heat therapy with an infrared belt reduced the severity of pain in the first stage of labor. The infrared belt could be used and recommended as a safe and effective pain relief in childbirth and maternity care. TRIAL REGISTRATION This study was registered in the Iran Clinical Trial Center with the code of IRCT20190805044446N1 .
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Affiliation(s)
- Fatemeh Dastjerd
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Erfanian Arghavanian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ameneh Sazegarnia
- Department of Medical Physics, Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Akhlaghi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Kordi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Sun H, Ma X, Wang S, Li Z, Lu Y, Zhu H. Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study. BMC Anesthesiol 2023; 23:185. [PMID: 37254106 DOI: 10.1186/s12871-023-02146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Epidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain. METHODS In this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture. RESULTS Seventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8-2.5) vs. 3.5 (3.3-4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups. CONCLUSIONS Pretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully. TRIAL REGISTRATION This trial was prospectively registered at Chictr.org.cn on 29/05/2020 with the registration number ChiCTR2000033356 ( http://www.chictr.org.cn/listbycreater.aspx ).
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Affiliation(s)
- Hao Sun
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, 230001, China
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
| | - Xiang Ma
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, 230001, China
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
| | - Shengyou Wang
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, 230001, China
| | - Zhenzhen Li
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, 230001, China
| | - Yao Lu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Haijuan Zhu
- Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, 230001, China.
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Yan W, Kan Z, Yin J, Ma Y. Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) As An Analgesic Intervention for Labor Pain: A Network Meta-analysis of Randomized Controlled Trials. Pain Ther 2023; 12:631-644. [PMID: 36934401 PMCID: PMC10199978 DOI: 10.1007/s40122-023-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Epidural analgesia (EA) is the most widely used intervention for the reduction of labor pain; however, it is contra-indicated for patients with spinal deformity or allergy to anesthetics and may be refused by parturients. As a noninvasive and nonnarcotic analgesic intervention, transcutaneous electrical acupoint stimulation (TEAS) has gained increasing attention in recent years. Therefore, we performed a network meta-analysis to compare the efficacy and safety of TEAS and EA as measured by visual analog scale score, the failure rate of natural delivery, adverse events, and Apgar scores. METHODS Relevant randomized controlled trials (RCTs) from four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane CENTRAL) and clinical trials.gov were searched from inception until September 4, 2022. A random effects model was used during analysis, and outcomes were evaluated as standard mean difference (SMD), odds ratio (OR), and 95% confidence intervals (CrI) using STATA (version SE15.0), R (version 3.6.1), and ADDIS (version 1.16.8) software. RESULTS Ten RCTs comprising 1214 parturients were identified by screening. Six RCTs compared TEAS and controls, three compared EA and controls, and one compared TEAS and EA. No heterogeneity was found within the four outcomes. There was no significant difference in any outcomes between interventions or control treatments in terms of SMD, OR, and CrI. Combined with the highest surface under the cumulative ranking curve score, TEAS demonstrated possible better effects in the aspects of analgesic efficacy and safety under certain circumstances. CONCLUSIONS TEAS may be a potential alternative for parturients as a simple, noninvasive, and non-pharmacological intervention compared with EA in terms of analgesic efficacy and safety for mothers and neonates.
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Affiliation(s)
- Wenli Yan
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Zunqi Kan
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jiahui Yin
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yuxia Ma
- Department of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Shandong, China.
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15
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Karatopuk S, Yarıcı F. Determining the effect of inhalation and lavender essential oil massage therapy on the severity of perceived labor pain in primiparous women: A randomized controlled trial. Explore (NY) 2023; 19:107-114. [PMID: 35987683 DOI: 10.1016/j.explore.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND This research aimed to reveal the effect of lavender essence inhalation and the massage therapy applied with lavender oil on the severity of labor pain of primiparous women. METHODS This randomized controlled trial was conducted with three groups. Pregnant women participating in the study were randomly divided into control group (n=40), lavender essence inhalation group (n=44) and lavender essence massage (n=37) groups. The applications were divided in three for each phase in the first stage of labor (early, active and transition). Thereafter sacral compression and circular massage were applied for 15 minutes on the lower back (waist) region of the participants by using 2 drops of lavender oil in each phase of labor; 2 drops of lavender oil were dripped onto the palms of the participants in the inhalation group by the researcher and they were asked to inhale it for 3 minutes. Research data were collected using Personal Information Form (PIF), Visual Analogue Scale (VAS) and Postpartum Assessment of Women Survey (PAWS). RESULTS The results of the research revealed that the labor pain perceived by the women who were applied inhalation and massage therapy using lavender essential oil were milder compared to the control group (p<0.05). Another finding of the research revealed that the lavender oil inhalation gave the best results in the latent phase, however the massage therapy with lavender oil was more effective in the active and transition phases. CONCLUSION Inhalation and massage therapy applied using lavender essential oil contributed to the alleviation of perceived labor pain. For this reason, massage therapy and inhalation applications using lavender oil are recommended to be applied by midwives as a complementary method to adapt to labor pain during delivery.
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Affiliation(s)
| | - Filiz Yarıcı
- Near East University, Faculty of Healty. Near East Boulevard, ZIP: 99138 Nicosia, TRNC Mersin 10 -, Turkey.
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16
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Kocak MY, Göçen NN, Akin B. The Effect of Listening to the Recitation of the Surah Al-Inshirah on Labor Pain, Anxiety and Comfort in Muslim Women: A Randomized Controlled Study. J Relig Health 2022; 61:2945-2959. [PMID: 34302588 DOI: 10.1007/s10943-021-01356-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to identify whether listening to the recitation of the Surah Al-Inshirah (94th Chapter of the Holy Qur'an) during labor had any effect on women's pain, anxiety and comfort levels. Designed as a randomized controlled trial, the study was performed with the participation of 126 pregnant Muslim women. The study showed that listening to the recitation of the Surah Al-Inshirah during labor had positive effects on the women's pain, anxiety and comfort levels. In this respect, it is recommended that based on individuals' religious beliefs, spiritual elements such as surahs, prayers and hymns be integrated into the midwifery care offered during labor.
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Affiliation(s)
- Mine Yilmaz Kocak
- Midwifery Department, Faculty of Health Science, Selcuk University, Aladdin Keykubat Campus Ardıçlı, No: 299, 42250, Selҫuklu, Konya, Turkey
| | - Nazlı Nur Göçen
- T.C. Ministry Health Konya Provincial Health Directorate Dr. Ali Kemal Belviranlı Obstetrics and Pediatrics Hospital, Konya, Turkey
| | - Bihter Akin
- Midwifery Department, Faculty of Health Science, Selcuk University, Aladdin Keykubat Campus Ardıçlı, No: 299, 42250, Selҫuklu, Konya, Turkey.
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Eyeberu A, Debela A, Getachew T, Dheresa M, Alemu A, Dessie Y. Obstetrics care providers attitude and utilization of non-pharmacological labor pain management in Harari regional state health facilities, Ethiopia. BMC Pregnancy Childbirth 2022; 22:389. [PMID: 35509044 PMCID: PMC9066716 DOI: 10.1186/s12884-022-04717-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background In a woman’s life, labor pain is the most severe pain that they have ever faced. In Ethiopia, the provision of pain relief in labor is often neglected. Furthermore, evidence strongly urged that further research is needed on non-pharmacological labor pain management. Therefore, obstetrics care providers’ attitudes and utilization of non-pharmacological labor pain management need to be assessed. Method A facility-based cross-sectional study was conducted from May 20 to June 10, 2021, in Harari regional state health facilities, Ethiopia. All obstetric caregivers in Harari regional state health facilities were included in the study. A structured questionnaire adapted from the previous studies was used to collect data. The data was entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out by using SPSS for windows version 22. Multivariate linear regression analysis was employed to determine the association between independent variables and the outcome variable. Result The overall utilization of non-pharmacological labor pain relief methods was 59.3% [(95% CI (53.9,63.4)]. Three hundred five (65.5%) of the study participants had unfavorable attitudes. Females compared to males (β = − 0.420; 95% CI: − 0.667, − 0.173), clinical experience (β = − 0.201; 95% CI: − 0.268, − 0.134), knowledge sum score (β =0.227: 95%; CI: 0.18,0.247), and attitude sum score (β = 0.376; 95% CI: 0.283, 0.47) were showed significantly association with utilization of non-pharmacological labor pain management. Conclusion The overall utilization of non-pharmacological labor pain relief methods was relatively good compared to other studies done in Ethiopia but all women’s need for labor relief methods should not be ignored. In this study sex of the respondents, clinical experience, individual preference, attitude and knowledge were factors associated with the utilization of non-pharmacological labor pain management. All stake holds need to work together to improve the attitude of health providers and to increase the utilization of non-pharmacologic labor pain management. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04717-9.
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Affiliation(s)
- Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Adera Debela
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Ebrahimian A, Bilandi RR, Bilandī MRR, Sabzeh Z. Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:49. [PMID: 35045813 PMCID: PMC8772130 DOI: 10.1186/s12884-021-04359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Childbirth pain and anxiety are often unnatural, as opposed to being one of the most practical ways to use non-pharmacological methods. The aim of this study was to compare the effectiveness of virtual reality and chewing mint gum on childbirth pain and anxiety. METHODS This is a single-blind, three-group clinical trial study on 93 mothers referred to Allameh Bohlool Gonabadi and Sajjadieh Torbate Jam Hospitals for natural childbirth in 2018-2019. Subjects were randomly divided into three groups of chewing gum, virtual reality, and control using six blocks. Chewing gum interventions in one group and virtual reality in the other group were performed twice in 4-5 cm and 7-8 cm dilatations for 20 min. In the control group, no intervention except routine care was performed. The research tools included Visual Analogue Scale of Pain and Spielberger's Anxiety Inventory. Data were analyzed using SPSS) version 22(, ANOVA, Kruskal-Wallis, Chi-square and Tukey tests. Significance level was considered 0.05 in this study. RESULTS The main result was differences in pain and anxiety before and after the intervention. There was no significant difference between pre-intervention pain and anxiety scores in the three groups, but there was a significant difference between pain and anxiety scores immediately and 30 min after the intervention. CONCLUSION The results of this study showed that virtual reality and chewing mint gum intervention reduce pain and anxiety in the first stage of childbirth. TRIAL REGISTRATION IRCT20181214041963N1 .
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Affiliation(s)
- Atefeh Ebrahimian
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
- School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Roghaieh Rahmani Bilandi
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran.
| | - Mohammad Reza Rahmani Bilandī
- Department of Midwifery, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
| | - Zahra Sabzeh
- Department of Midwifery, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
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Sun L, Zhang H, Han Q, Feng Y. Electroencephalogram-derived pain index for evaluating pain during labor. PeerJ 2022; 9:e12714. [PMID: 35036175 PMCID: PMC8710049 DOI: 10.7717/peerj.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background The discriminative ability of a point-of-care electroencephalogram (EEG)-derived pain index (Pi) for objectively assessing pain has been validated in chronic pain patients. The current study aimed to determine its feasibility in assessing labor pain in an obstetric setting. Methods Parturients were enrolled from the delivery room at the department of obstetrics in a tertiary hospital between February and June of 2018. Pi values and relevant numerical rating scale (NRS) scores were collected at different stages of labor in the presence or absence of epidural analgesia. The correlation between Pi values and NRS scores was analyzed using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to estimate the discriminative capability of Pi to detect labor pain in parturients. Results Eighty paturients were eligible for inclusion. The Pearson correlation analysis exhibited a positive correlation between Pi values and NRS scores in parturients (r = 0.768, P < 0.001). The ROC analysis revealed a cut-off Pi value of 18.37 to discriminate between mild and moderate-to-severe labor pain in parturients. Further analysis indicated that Pi values had the best diagnostic accuracy reflected by the highest area under the curve (AUC) of 0.857, with a sensitivity and specificity of 0.767 and 0.833, respectively, and a Youden index of 0.6. Subgroup analyses further substantiated the correlations between Pi values and NRS scores, especially in parturients with higher pain intensity. Conclusion This study indicates that Pi values derived from EEGs significantly correlate with the NRS scores, and can serve as a way to quantitatively and objectively evaluate labor pain in parturients.
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Affiliation(s)
- Liang Sun
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Hong Zhang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Qiaoyu Han
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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Karaman N, Ceylantekin Y. Effect of nursıng support gıven to pregnant women on labor paın and bırth expectancy. Afr J Reprod Health 2021; 25:110-120. [PMID: 37585826 DOI: 10.29063/ajrh2021/v25i6.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Nurses support pregnant women in coping with their labor pain. The aim of the quasi-experimental correlational design study was to identify the effect of the nursing support provided on labor pain and birth expectations to primiparous pregnant women. This study was carried out with an intervention (n=51) and control group (n=51) of primiparous women who were in their 37-41 weeks of pregnancy. In the first stage of labor (latent phase-active phase) (3-7 cm dilatation), the following procedures were applied respectively. Focusing, imagery, massage, sacral pressure, and breathing-relaxation-pushing exercises were explained to the pregnant women in the intervention group by the researcher and the exercises were practised one-on-one with them. The control group only received standard care in the ward without any intervention. The population of the study consisted of 102 pregnant women aged 18 years and above who had a vaginal delivery between February 15- August 15, 2018.The data of the study were collected using the Pregnancy Diagnosis Form, the Visual Analog Scale (VAS) (labor VAS1, post-natal VAS2) to determine the pain level of the participants, and WIJMA Labor Expectancy/Experience Questionnaire Version B to determine their expectations. SPSS 22.0 for Windows was used for the data analysis while frequency and percentage distribution, arithmetic means were calculated. Mann-Whitney U test, Kruskal- Wallis test, Spearman correlation analysis were performed. The statistical significance level was accepted as p <0.05. The socio-demographic and obstetric characteristics of the pregnant women in the study were similar. VAS1 was 6.0 1.3 in the intervention group and 6.4 .1 in the control group. VAS2 was 0.9 0,8 in the intervention group and 1.31 1,029 in the control group. Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) Version B was found to be7.3 14.9 in the intervention group and 117.1 23.9 in the control group. The study results showed that the pregnant women in the intervention group described their labor more positively, that the postpartum perceived pain, fear levels of pregnant women who received nursing support were lowerthanthosewhoreceivedstandardcare.
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Affiliation(s)
| | - Yeşim Ceylantekin
- Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Turkey
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Warner LL, Arendt KW, Theiler RN, Sharpe EE. Analgesic considerations for induction of labor. Best Pract Res Clin Obstet Gynaecol 2021; 77:76-89. [PMID: 34627722 DOI: 10.1016/j.bpobgyn.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Abstract
Induction of labor may be indicated to minimize maternal and fetal risks. The rate of induction is likely to increase as recent evidence supports elective induction at 39 weeks gestation. We review methods of induction and then analgesic options as they relate to indications and methods to induce labor. We specifically focus on parturients at high risk for anesthetic complications including those requiring anticoagulation, and those with cardiac disease, obesity, chorioamnionitis, prior spinal instrumentation, elevated intracranial pressure, known or anticipated difficult airway, thrombocytopenia, and preeclampsia. Guidelines regarding timing of anticoagulation dosing with neuraxial anesthetic techniques have been defined through consensus statements. Early epidural placement may be beneficial in patients with cardiac disease, obesity, anticipated difficult airway, and HELLP syndrome. Questions remain regarding how early is too early for epidural placement, what options are safest for patients with bacteremia, and what pain relief should be offered to those unable to tolerate cervical exams in early labor.
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Affiliation(s)
- Lindsay L Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States.
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
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22
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Deng Y, Lin Y, Yang L, Liang Q, Fu B, Li H, Zhang H, Liu Y. A comparison of maternal fear of childbirth, labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study. Int J Nurs Sci 2021; 8:380-387. [PMID: 34631987 PMCID: PMC8488849 DOI: 10.1016/j.ijnss.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/13/2021] [Accepted: 09/09/2021] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth. Methods A convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump. Results Eighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman's correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth. Conclusions Fear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.
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Affiliation(s)
- Yongfang Deng
- Department of High-Risk Obstetric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liyuan Yang
- Department of High-Risk Obstetric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiuxia Liang
- Department of Gynaecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bailing Fu
- Department of Gynaecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huizhu Zhang
- Delivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Liu
- Delivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Yasar E, Uysal AI. Erector spinae plane blockade in the first stage of labour: a case series. Braz J Anesthesiol 2021:S0104-0014(21)00373-0. [PMID: 34626755 DOI: 10.1016/j.bjane.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 09/06/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The objective of this case series was to present the importance of labour analgesia and the preference for erector spinae plane (ESP) block as a new technique that can be used for labour analgesia. Case reports The three patients were 25-year-old primipara with 5-cm cervical dilation, a 30-year-old multiparous with 5-cm cervical dilatation, and a 32-year-old primipara with 4-cm cervical dilation. Conclusions Bilateral ESP block may be an alternative analgesic technique for the first stage of labour.
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Linzbach A, Nitschke D, Rothaug J, Komann M, Weinmann C, Schleußner E, Meißner W, Jimenez Cruz J, Schneider U. Peripartal pain perception and pain therapy: introduction and validation of a questionnaire as a quality instrument. Arch Gynecol Obstet 2021; 305:1409-1419. [PMID: 34542680 PMCID: PMC9166832 DOI: 10.1007/s00404-021-06246-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Labor pain is difficult to measure. The aim of this proof-of-concept study is to implement and test a questionnaire assessing pain sensation during and after vaginal deliveries. Its key aspect is a highly standardized survey of patient-reported outcome (PRO) by staff not involved in routine care. METHODS Between January and November 2015 339 women were assessed 24-48 h after spontaneous or operative-vaginal delivery of a singleton. German language skills were a prerequisite to participate. The test-retest reliability was calculated in 38 women 24-36 and 48-72 h postpartum between July and October 2017. Primiparae after spontaneous delivery and multiparae with no history of operative deliveries were compared in a subgroup analysis. RESULTS Maximum labor pain and post-partum pain were reported a median of 9 [8-10] and 4 [3-6]. Higher ratings were associated with younger age, higher gestational ages, infant's biometrics, and the duration of laboring. Only regional analgesia tended to reduce pain perception (NRS 8 vs. 9). Higher-degree injuries were associated with less pain postpartum. The questionnaire proved to be reliable in most aspects (Cronbach's α > 0.6 for 19/21 questions) and showed an acceptable content and criterion validity (Cohen correlation > ± 0.3, interrelation between items). CONCLUSION Labor is a very painful experience, irrespective of previous obstetric history. Ratings indicate inadequateness of treatment except for patients receiving preventive postoperative pain management. Systematic postpartum pain assessment, hence, is still a pending issue. Adjustments will be made concerning language skills and specific questions on effectiveness of analgesia otherwise good reliability and validity of the questionnaire were proven.
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Affiliation(s)
- A Linzbach
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - D Nitschke
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Rothaug
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Komann
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - C Weinmann
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - E Schleußner
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - W Meißner
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - J Jimenez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - U Schneider
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Rinaldi L, Ghirardini AM, Troglio R, Bellini V, Donno L, Biondini S, Biagioni E, Baciarello M, Bignami E, Girardis M. Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial. J Anesth Analg Crit Care 2021; 1:2. [PMID: 37386624 DOI: 10.1186/s44158-021-00003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Automated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload. RESULTS Six hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group. CONCLUSIONS Our study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols.
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Affiliation(s)
- Laura Rinaldi
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy.
| | - Anna Maria Ghirardini
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Raffaella Troglio
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Valentina Bellini
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Lara Donno
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Susanna Biondini
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Marco Baciarello
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Elena Bignami
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
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Yuan YJ, Luo X, Xue FS. Oral acetaminophen and patient-controlled epidural analgesia. J Anesth 2021; 36:328. [PMID: 34379201 DOI: 10.1007/s00540-021-02984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Yu-Jing Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Xin Luo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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27
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Shaterian N, Pakzad R, Fekri SD, Abdi F, Shaterian N, Shojaee M. Labor Pain in Different Dilatations of the Cervix and Apgar Scores Affected by Aromatherapy: A Systematic Review and Meta-analysis. Reprod Sci 2021; 29:2488-2504. [PMID: 34231175 DOI: 10.1007/s43032-021-00666-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022]
Abstract
Labor pain (LP), as a physiological process, is known as one of the most severe pains. Aromatherapy is one of the methods to reduce LP in the first phase of labor. It is an important approach for enjoyable birth and decreases the severity of pain in today's society. Accordingly, this study aimed to systematically review the relieving effect of aromatherapy in LP and Apgar score. We used international databases such as EMBASE, Web of Science, Scopus, Google Scholar, PubMed, Cochrane Library, ProQuest, and clinicaltrials.gov to conduct a systematic search for all relevant articles. Cochran's Q-test and I2 statistic were applied to assess heterogeneity, a random-effects model was used to estimate the unstandardized mean difference (UMD), and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies. A total of 27 studies were included in the meta-analysis (sample size: 2,566). Overall, aromatherapy leads to relieving LP during delivery (UMD: 1.75; 95% CI: 1.13-2.37). Based on cervix dilation, aromatherapy significantly affects LP when cervix dilation is 8-10 cm (UMD: 6.18; 95% CI: 4.51-7.85) and 0-4 cm (UMD: 5.31; 95% CI: 3.74-6.87); but it had no effects on 1- and 5-min Apgar scores. No publication bias was observed (P=0.113). Mother's age, publication year, sample size, and cervix dilation had no significant effects on heterogeneity (P>0.05). Aromatherapy had a positive impact on relieving LP, and the greatest and least effect was witnessed in dilatation of 8-10 cm and 0-4 cm, respectively. Moreover, it had no effects on 1- and 5-min Apgar scores.
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Affiliation(s)
- Negin Shaterian
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Fatemeh Abdi
- School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran. .,Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Negar Shaterian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mina Shojaee
- Department of Midwifery, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ghandali NY, Iravani M, Habibi A, Cheraghian B. The effectiveness of a Pilates exercise program during pregnancy on childbirth outcomes: a randomised controlled clinical trial. BMC Pregnancy Childbirth 2021; 21:480. [PMID: 34215198 PMCID: PMC8253242 DOI: 10.1186/s12884-021-03922-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Performing exercise with medium intensity has positive effects on the maternal health. The aim of this study was to investigate the effectiveness of Pilates exercise program during pregnancy on childbirth outcomes: Methods This clinical trial study was performed on 110 primiparous women who were randomly divided into two groups of intervention (n = 55) and control (n = 55). The intervention group performed Pilates exercises from 26 to 28 weeks of gestation for 8 weeks while the control group did not do any exercise. Data collection tools included Visual Analog Scale (VAS), Mackey Childbirth Satisfaction Rating Scale, and a checklist including demographic and obstetrics information. Results The results of the study showed that Pilates exercise during pregnancy significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process (p < 0.05). Based on the Kaplan Meyer analysis, the mean whole length of labor was shorter in Pilates exercise group than in the control group (P = .004). There was no statistically significant difference between the two groups in terms of Episiotomy, type of delivery, first and fifth Apgar score of neonates (p > 0.05). Conclusion According to the results of this study, Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction of chidbirthprocess, without causing complications for the mother and baby. However, studies with larger sample sizes are recommended to prove the efficacy and safty of this practiceduring labor. Trial registration IRCT registration number:IRCT20200126046266N1. Registration date: 2020-05-02 (retrospectively registered).
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Affiliation(s)
- Nasim Yousefi Ghandali
- School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery and reproductive health Department, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Abdolhamid Habibi
- Faculty of Sports Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Rosmiarti, Ria G, Maya A, Jamalluddin SB. Murotal Al-Quran therapy on decreasing labor pain and anxiety in maternity mothers first phase. Enferm Clin 2020; 30 Suppl 5:110-4. [PMID: 32713546 DOI: 10.1016/j.enfcli.2019.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Childbirth is a physiological event in every development of a woman to become a mother. This event can cause trauma because of the pain she experienced. The main factors in labor are passage, passager and power, psychological (psychological factors) and childbirth helpers. A woman needs physical, emotional, psychosexual and psychosocial maturity before marriage and becomes pregnant. Feelings of anxiety, fear of pain will make women uneasy facing pregnancy, childbirth and childbirth, non-pharmacological therapy that can be given in various ways, namely; acupressure, acupuncture, cold compresses, warm compresses, hydrotherapy, hypnotherapy, endorphin massage, relaxation and distraction techniques. The effectiveness of giving murotal Al-Quran audio will increase the power of faith and provide peace of mind. OBJECTIVES The purpose of this study is to determine the effectiveness of Murotal Al Quran Therapy on Decreasing Labor Pain and Anxiety in Maternity in the First Phase in Maternity Clinic Ar-Rahmah Indralaya Ogan Ilir. The population of this research was maternity inpartu when I was an active phase which amounted to 20 people. METHODS The type of research used in this study was quasi-experiment. The research design used was one group comparison pretest-posttest design to test the intensity of pain intensity using Shapiro-Wilk. RESULT From the results of the study obtained the normality test obtained p=0.039 and 0.069 which showed the data did not normally distribute, the difference between before and after being given Murotal Al-Quran 0.30 with p=0.008 showed that there was a difference in pain scale before and after therapy Murotal Al-Quran, for the anxiety of the difference between before and after being given therapeutic Murotal Al-Quran 0.021 with p=0.025 which shows that there are differences in pain scale before and after the Murotal Al-Quran is concluded. CONCLUSION It can be concluded that Murotal Al-Quran can reduce pain and anxiety in maternity when I was an active phase. It is expected that midwives can improve services through the development of midwifery care, especially for women who experience severe pain.
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30
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Njogu A, Qin S, Chen Y, Hu L, Luo Y. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth 2021; 21:164. [PMID: 33627077 PMCID: PMC7905652 DOI: 10.1186/s12884-021-03625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Labor pain during childbirth can have devastating effects on the progress of labor, mother, and fetus. Consequently, the management of labor pain is crucial for the well-being of the mother and fetus. Transcutaneous electrical nerve stimulation (TENS) is a non -pharmacological analgesic technique. It uses a low-voltage electrical current to activate descending inhibitory systems in the central nervous system to relieve pain. This study aimed to determine the effects of TENS therapy in the first stage of labor. METHODS In this single-blind randomized controlled trial, we screened low-risk pregnant women who anticipated spontaneous vaginal delivery. Women were assigned (1:1) to either the experimental group (received TENS therapy in the first stage of labor) or the control group (received routine obstetric care). The women, midwives, and researchers working in the gynecology and obstetric department were aware of the treatment group, but statisticians analysis the data were blinded. The primary outcome was labor pain intensity, assessed by visual analog scale (VAS) immediately after the randomization, at 30, 60, and 120 min after TENS therapy, and 2-24 h post-delivery. We used SPSS 21.0 software in data analysis. An independent sample t-test compared the mean VAS scores and labor duration between groups. A Chi-square test was employed to compare categorical variables between the groups. A significant level of ≤0.05 was statistically significant. RESULTS A total of 326 pregnant women were eligible: experimental group (n = 161) and control group (n = 165). The experimental group had statistically significantly lower mean VAS scores at a different time (30, 60, and 120 min post-intervention and 2-24 h post-delivery) than the control group (p < 0.001). The experimental group demonstrated a statistically significant shorter duration of the active labor phase than the control group (p < 0.001). CONCLUSION This study indicates that TENS can be used as a non-pharmacological therapy to reduce pain and shorten the active labor phase. TRIAL REGISTRATION ISRCTN registry, ISRCTN23857995 . Registered on 11/12/2020, 'retrospectively registered.
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Affiliation(s)
- Anne Njogu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Si Qin
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yujie Chen
- Department of Nursing, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Lizhen Hu
- Department of Nursing, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yang Luo
- Xiangya School of Nursing, Central South University, Changsha, China.
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31
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Torkiyan H, Sedigh Mobarakabadi S, Heshmat R, Khajavi A, Ozgoli G. The effect of GB21 acupressure on pain intensity in the first stage of labor in primiparous women: A randomized controlled trial. Complement Ther Med 2021; 58:102683. [PMID: 33607215 DOI: 10.1016/j.ctim.2021.102683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/16/2020] [Accepted: 02/09/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Labor pain is one of the most intensive pains experienced by women; it results in physical, emotional, and physiological changes in women's body. The present study aimed to examine the effect of GB21 acupressure on labor pain. DESIGN In this randomized clinical trial, 174 primiparous women in their first stage of labor were selected and assigned to three groups: GB21 acupressure group (n = 58), sham group (n = 58), and control group (n = 58). INTERVENTIONS The acupressure and sham groups received routine labor care and acupressure in three different phases of cervical dilations to 3-5 cm, 6-7 cm, and 8-10 cm. The control group received routine care in labor. MAIN OUTCOME MEASURES Pain severity was measured using a pain scale ruler in three cervical dilations before and after intervention. The collected data were analyzed using the ANOVA, Kruskal-Wallis, paired-t test and Mann-Whitney tests. RESULTS Pain reduction was significantly higher in GB21 groups compared with sham and control groups (P = 0.001). No statistically significant difference was observed between the three groups in terms of delivery outcomes. CONCLUSIONS In this study, GB21 acupressure was effective in pain relief during labor, hence recommended as a practical, effective, inexpensive, and accessible method for labor pain management.
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Affiliation(s)
- Hamideh Torkiyan
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sedigheh Sedigh Mobarakabadi
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Heshmat
- Iranian Scientific Acupuncture Association, Tehran, Iran.
| | - Alireza Khajavi
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Dorairajan G, Gopalakrishnan V, Chinnakali P, Balaguru S. Experiences and Felt Needs of Women During Childbirth in a Tertiary Care Center: a Hospital-Based Cross-Sectional Descriptive Study. J Obstet Gynaecol India 2021; 71:21-26. [PMID: 33814795 PMCID: PMC7960873 DOI: 10.1007/s13224-020-01359-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Childbirth experience is unique to every woman. Negative experience is detrimental to both mother and child. This study was undertaken to understand the positive and negative experience and felt need of women undergoing labor and the factors affecting them. METHODOLOGY This cross-sectional descriptive quantitative study was conducted among women who delivered in JIPMER and consented to participate through a questionnaire that captured four areas of childbirth experience. The study was carried out before the LaQshya guidelines were implemented. RESULTS Three hundred and seventy women completed the study. The mean age of women in this study was 24.5 years and 60% were primipara. Five women (1.3%) experienced physical abuse. Another 47 (12.7%) experienced disrespect in the form of scolding/insult/discrimination or nonconsented care. Three-fourths of the women wanted a relative (majority preferred their mother) with them, and 54% wanted a prayer hall in the labor room. On univariate analysis, no significant determinant was found for negative experience constituting disrespect and abuse. Complete pain relief as a need was found to be significantly higher (X2 = 11.0783, p < 0.004) in women of lower parity. The women educated beyond scholastic level felt that information given about delivery is inadequate when compared to participants who were illiterate or had primary education only. CONCLUSIONS In our hospital 12.7% women undergoing labor experienced disrespectful behavior and 1.3% experienced physical abuse. Need for prayer hall, complete pain relief and presence of relative was felt by more than half of the participants. We did not find any specific factor influencing the negative experience.
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Affiliation(s)
- Gowri Dorairajan
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Second Floor, Women, and Child Block, Puducherry, 605006 India
| | - Vandana Gopalakrishnan
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Second Floor, Women, and Child Block, Puducherry, 605006 India
| | - Palanivel Chinnakali
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subhalakshmi Balaguru
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Second Floor, Women, and Child Block, Puducherry, 605006 India
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Gür EY, Apay SE. The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial. Midwifery 2020; 91:102856. [PMID: 33478718 DOI: 10.1016/j.midw.2020.102856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study was conducted to investigate the effects of cognitive behavioral techniques using virtual reality on birth pain. DESING This study was planned as a double blind randomized controlled experimental study. SETTING AND PARTICIPANTS It was conducted with 273 pregnant women who were randomized between July 2016 and June 2019 at maternity hospital located in eastern Anatolia, Turkey. METHODS The study included 5 groups. (A: videos of newborn photographs with classical music, B: the video of the newborn photograph album, C: an introductory film of Turkey, D: only classical music, E: routine hospital care). The data were collected by using the "Personal Information Form", "Visual Analogue Scale", "Verbal Rating Scale" and "Virtual Reality". FINDINGS Groups show homogeneity in terms of demographic and obstetric variables. It was found that mean Visual Analogue Scale posttest mean score of the group A was 4.98 ± 1.69; group B 4.96 ± 1.72; group C 5.96 ± 2.05; group D 5.60 ± 1.63 and group E 6.38 ± 1.86. Mean Verbal Rating Scale posttest score was found that group A was 2.64 ± 0.73, group B 2.70 ± 0.87, group C 3.18 ± 1.14, group D was 2.80 ± 0.86 and group E was 3.96 ± 1.01. It was obtained that the groups' mean Visual Analogue Scale and Verbal Rating Scale posttest mean scores was statistically significant (p<0.05). CONCLUSION In this study, all cognitive techniques applied with virtual reality reduced labor pain during the active phase of labor. Especially the video of newborn photographs with classical music and newborn photograph album have been found more effective than other interventions evaluated in reducing labor pain. IMPLICATIONS FOR PRACTICE Midwives can use these techniques to reduce birth pain.
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Affiliation(s)
- Elif Yagmur Gür
- Ataturk University Health Science, Faculty Midwifery Department, Erzurum, Turkey.
| | - Serap Ejder Apay
- Ataturk University Health Science, Faculty Midwifery Department, Erzurum, Turkey
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Abstract
Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it leads to higher maternal satisfaction and good maternal and fetal safety profiles. We examine the controversies and myths concerning the initiation, maintenance, and discontinuation of epidural analgesia. Recent evidence will also be reviewed to address concerns about the effects of epidural analgesia on the rates of instrumental and operative delivery, lower back pain, and breastfeeding. New developments in labour analgesia are also discussed.
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Affiliation(s)
- K K Lam
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
| | - M K M Leung
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
| | - M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
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Türkmen H, Oran NT. Massage and heat application on labor pain and comfort: A quasi-randomized controlled experimental study. Explore (NY) 2021; 17:438-45. [PMID: 32828687 DOI: 10.1016/j.explore.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to determine the effects of sacral massage and heat application on the perceptions of labor pain and comfort level in pregnant women. METHODS This was a quasi-randomized controlled experimental study. The data were collected under three groups in 2016: the heat application group (HAG), the massage group (MG), and the control group (CG). Each group included 30 primiparous pregnant women (range of age: 17-35) whose cervix was dilated to 4-5 cm. At 4-5 cm, 6-7 cm, and 8-9 cm cervical dilation, sacral massage was applied to MG, and sacral heat application was applied to HAG. Each group received standard midwifery care during labor. The data were collected using the Childbirth Comfort Questionnaire (CCQ) and the Numerical Rating Scale (NRS). The data were analyzed by using the Chi-square test, the Friedman test, Paired sample t-test, ANOVA, the Kruskal-Wallis test, and Wilcoxon signed-ranks test RESULTS: The mean pain score in HAG (4.56±0.67) during 4-5 cm of cervical dilation was significantly lower than those in MG (5.03±1.06) or CG (5.23±0.72) (p < 0.05). The mean pain scores in HAG (6.80±0.7) and MG (7.30±0.8) during 6-7 cm of cervical dilation were significantly lower than that in CG (7.70±0.5) (p < 0.001). Moreover, a statistically significant difference was found between the mean CCQ total scores (HAG: 31.06±3.46, CG: 27.66±3.85, p < 0.05), mean CCQ physical comfort scores (HAG: 13.16±1.89, CG: 11.03±1.80, p < 0.001), mean CCQ relief comfort level score (HAG: 11.23±1.43, CG: 10.00±2.01, p < 0.05) and mean CCQ transcendence comfort level scores (HAG: 19.83±2.37, CG: 17.66±2.15, p < 0.05) and both HAG and CG during 8-9 cm of cervical dilation. CONCLUSIONS Heat application and massage can be used as a safe and effective midwifery intervention to reduce the perception of pain in pregnant women and provide comfort during labor.
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Mathur VA, Morris T, McNamara K. Cultural conceptions of Women's labor pain and labor pain management: A mixed-method analysis. Soc Sci Med 2020; 261:113240. [PMID: 32758799 DOI: 10.1016/j.socscimed.2020.113240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/25/2023]
Abstract
AIM We assess American cultural beliefs about labor pain and labor pain management, including stereotypical and disparate beliefs about labor pain of women from different racial groups. RATIONALE Understanding cultural beliefs about labor pain is critical as these beliefs influence experience, interpretation, and treatment of labor pain. METHOD We used an online survey with quantitative and qualitative questions about American labor pain beliefs. Participants were recruited and compensated using TurkPrime's Panels during the first week in August 2017 and the last week in May 2018. The completion rate was 76.86 percent (n = 214). After screening using quality control items, the final sample included 200 respondents. RESULTS Qualitative results indicate that 56.5 percent (n = 113) of respondents have an accurate understanding of nociceptive/sensory drivers of labor pain, and 55.8 percent (n = 63) of those respondents focused on the second stage of labor. However, only two respondents (1%) mentioned non-sensory (i.e., psychological) causes of labor pain - reflecting a lack of cultural knowledge of the biopsychosocial nature of pain. Categorical responses indicate almost all respondents (95%; n = 190) believe women have a right to labor pain relief, and the majority believe labor pain has value (68%; n = 136) and should be treated medically (87%; n = 174). Quantitative results document stereotypical beliefs that women of color experience less labor pain than white women. Belief that there is value in experiencing labor pain and that pain should not be treated medically were both associated with greater racial disparities in beliefs about labor pain severity. Beliefs were not related to respondent sociodemographic identity, suggesting they are American cultural constructs. CONCLUSION Future consideration of the influence of dominant American cultural beliefs about labor pain - including misunderstanding of the nature of labor pain and racial bias in expectations of labor pain - on individuals, norms, and structures is expected to improve quality of patient care.
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Cheng WJ, Hung KC, Ho CH, Yu CH, Chen YC, Wu MP, Chu CC, Chang YJ. Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study. BMC Pregnancy Childbirth 2020; 20:413. [PMID: 32689958 PMCID: PMC7370438 DOI: 10.1186/s12884-020-03085-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background The explanation of epidural analgesia by anesthesiologist would often begin after the parturient is admitted to the hospital. Because of labor pain, the decision of receiving epidural analgesia would often be made by the family members, instead of the parturient herself. We aimed to test whether earlier prenatal shared decision-making (SDM) interventions increase parturient’s comprehension and satisfaction of epidural labor analgesia, compared to conventional explanation after labor pain begun. Methods During the 28th week of gestation, we provided the SDM parturient health education as well as a leaflet with quick response codes. Scanning the code would link to education videoclips which explained what epidural analgesia is and its advantages and disadvantages. Original routine practice group parturients received explanation of analgesia after admission for delivery. To measure the satisfaction of labor pain service, the accessibility of information, and the communication with medical staff, we designed a questionnaire with reference to (1) Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), (2) Preterm Birth Experience and Satisfaction Scale (P-BESS), and (3) Women’s Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ). The questionnaire was amended after a pretest involving 30 parturients who had received epidural analgesia. Scree test analysis and exploratory factor analysis were performed; then, the questionnaire was revised again. A total of 200 valid questionnaires were collected—100 each from the original routine practice group and the SDM group. Results The SDM group reported significantly higher satisfaction with and understanding of epidural analgesia, and a significantly higher satisfaction with the information received, and the quality of pain relief. After SDM intervention, significant increasement of the average satisfaction scores in question “my epidural is effective” (9.10%; mean difference: 0.38; 95% confidence interval, 0.17 ~ 0.59; p < 0.001) and “The effect of epidural is just as what I have expected” (10.41%; mean difference: 0.41; 95% confidence interval, 0.18 ~ 0.64; p < 0.001) was demonstrated. Conclusions An earlier prenatal SDM intervention with sufficient information through videoclips increased parturients’ comprehensions and satisfaction of epidural analgesia service. Trial registration ISRCTN registry, 14,256,563. Registered April 1st, 2020 (10.1186/ISRCTN14256563).
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Affiliation(s)
- Wan-Jung Cheng
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan.
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Wu Q, Liu Z, Pang X, Cheng L. Efficacy of five-element music interventions in perinatal mental health and labor pain: A meta-analysis. Complement Ther Clin Pract 2020; 40:101217. [PMID: 32763833 DOI: 10.1016/j.ctcp.2020.101217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the efficacy of five-element music interventions in perinatal mental health and labor pain. To provide evidence for future research on Chinese Traditional Music Interventions. METHODS An electronically search was conducted in Web of Science, PubMed, EMbase, The Cochrane Library, CNKI databases, WanFang Data and VIP Database for Chinese Technical Periodicals from inception to January 07, 2020 to collect randomized controlled trials (RCTs) on five-element music interventions for prenatal, perinatal and postpartum women. Literature screening, data extraction, and the risk of bias assessment of all eligible studies were conducted by two reviewers independently. Then, meta-analysis was performed by RevMan 5.3 software. RESULTS A total of 13 RCTs involving 2387 patients were included. The results of meta-analysis showed that five-element music could significantly improve the depression levels (SMD = -2.03, 95%CI: -2.88 to -1.19, P < 0.00001), anxiety levels (SMD = -3.49, 95%CI: -4.47 to -2.24, P < 0.00001) and severe anxiety rate (OR = 0.42, 95%CI: 0.19 to 0.94, P = 0.04) of perinatal women. Additionally, five-element music produced significant effects on labor pain (MD = -0.67, 95%CI: -0.82 to -0.52, P < 0.00001), labor duration (MD = -0.85, 95%CI: -1.07 to -0.63, P < 0.00001), the hemorrhage 2 h after parturition (MD = -19.55, 95%CI: -35.56 to -3.54, P = 0.02) and the Serum DYN expression level (MD = 1.32, 95%CI: 0.23 to 2.40, P = 0.02). CONCLUSIONS Five-element music may be efficacious in improving perinatal women' depression, anxiety, labor pain, labor duration, the hemorrhage 2 h after parturition and the Serum DYN expression level. Because of the limitation of quantity and quality of included studies, more high-quality studies were needed to confirm the above conclusion.
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Affiliation(s)
- Qi Wu
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China
| | - Zhijian Liu
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China
| | - Xiaoli Pang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China.
| | - Ling Cheng
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, PR China
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Babaoğlu G, Kiliçaslan B, Ankay Yilbaş A, Çelebioğlu B. Effects of different analgesic methods used for vaginal delivery on mothers and fetuses. Turk J Med Sci 2020; 50:930-936. [PMID: 32394678 PMCID: PMC7379442 DOI: 10.3906/sag-1911-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 05/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background/aim Knowledge regarding pain relief during labor remains insufficient. We aimed to determine and compare the effectiveness and safety of epidural analgesia, combined spinal–epidural analgesia, and parenteral meperidine on both mothers and fetuses. Materials and methods This study was designed as an observational case-control study. We collected prospective data from patients whose labor pain management was conducted with meperidine in addition to retrospective cohort data of neuraxial methods; 138 patients were enrolled. Epidural analgesia group consisted of 68 patients, whereas combined spinal-epidural (CSE) analgesia group and meperidine group consisted of 50 and 20 patients, respectively. We compared the delivery patterns, labor durations, pain levels, side effects, maternal satisfaction levels, and neonatal outcomes of the various pain management methods. Results Patient demographics, duration of first, second, and third labor stages, and instrumental delivery rates were comparable among groups (P > 0.05). Cesarean section tended to be less frequent in the CSE group. In the meperidine group, visual analog scale (VAS) values and sedation were significantly higher (P < 0.001) and maternal satisfaction lower (P < 0.001). Hypotension tended to be more frequent in the meperidine group. APGAR scores at the 1st and 5th min were similar among the groups and between meperidine subgroups defined by three different administration times (<1 h, 1‒4 h, ≥4 h; P > 0.05). Conclusion Neuraxial methods had no effect on instrumental delivery rates. CSE represented a near significant risk reduction in cesarean section. Our results demonstrated that regional analgesia methods were reasonably safe for both mother and fetus, and regional analgesia methods resulted in greater maternal satisfaction and pain control compared to meperidine.
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Affiliation(s)
- Gülçin Babaoğlu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Banu Kiliçaslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysun Ankay Yilbaş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bilge Çelebioğlu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Glavind J, Greve T, de Wolff MG, Hansen MK, Henriksen TB. Medication used in Denmark in the latent phase of labor - Do we know what we are doing? Sex Reprod Healthc 2020; 25:100515. [PMID: 32361536 DOI: 10.1016/j.srhc.2020.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the various combinations of medication used in Denmark in the latent phase of labor (i.e. for therapeutic rest) and to estimate the frequency of use. METHODS An informal e-mail survey based on personal information from Danish midwives or staff obstetricians. The main outcome measures were type and dosage of medications used individually or in combination ("cocktail") for therapeutic rest in Danish delivery wards during the latent phase of labor and also the frequency of their use. RESULTS All twenty-one delivery wards in Denmark participated in the survey. The types and dosages of medication varied substantially. Two delivery wards used prescriptions on morphine with no other medication for therapeutic rest. The remaining 19/21 delivery wards (90%) used a standard "cocktail" with two to four different types of medications; 19/21 wards (90%) used a mild analgesic (paracetamol), 17/21 (81%) used anxiolytics/hypnotics, and 14/21 (64%) wards used a strong analgesic (opioid) in their basic cocktail. Ten delivery wards (48%) combined an opioid, a sedative, and paracetamol in their basic cocktail. Between 7% and 21% of all pregnant women were given a cocktail. CONCLUSION In a small country, we found considerable national variation in the medication or combinations of medication used in the latent phase of labor, and polypharmacy was standard in the majority of the delivery wards.
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
| | - Tine Greve
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mette Kabell Hansen
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Tine Brink Henriksen
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
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Alimoradi Z, Kazemi F, Gorji M, Valiani M. Effects of ear and body acupressure on labor pain and duration of labor active phase: A randomized controlled trial. Complement Ther Med 2020; 51:102413. [PMID: 32507430 DOI: 10.1016/j.ctim.2020.102413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study sought to compare the effects of multi-point ear and body acupressure on labor pain and the duration of labor active phase. DESIGN Three-armed randomized controlled trial. SETTING Kowsar Hospital, Qazvin, Iran. INTERVENTION Participants in the body acupressure group received acupressure on GB21, GB30, BL32, LI4, and SP6 points, each for two minutes, at cervical dilation of four, six, and eight centimeters. For participants in the ear acupressure group, adhesive auriculotherapy-specific Vaccaria seeds were attached to their auricles on the zero, genitalia, Shen Men, thalamic, and uterine 1 and 2 acupoints. The seeds were compressed every thirty minutes, each time for thirty seconds. Participants in the control group received routine care services. MAIN OUTCOME MEASURES Labor pain intensity was assessed using a visual analogue scale at cervical dilation of four and ten centimeters. RESULTS While there was no significant difference between mean scores of pain among three groups, mean score of labor pain in both acupressure groups was significantly less than that in the control group (P < 0.001). However, the difference between the acupressure groups was not statistically significant (P = 0.12). Moreover, the duration of labor active phase in the ear acupressure group was significantly less than those in the body acupressure and the control groups (P < 0.001). CONCLUSION Ear acupressure was significantly effective in reducing labor pain and shortening labor active phase. However, body acupressure solely reduces labor pain. Therefore, ear acupressure can be used to reduce labor pain and shorten labor active phase.
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Nanji JA, Carvalho B. Pain management during labor and vaginal birth. Best Pract Res Clin Obstet Gynaecol 2020; 67:100-112. [PMID: 32265134 DOI: 10.1016/j.bpobgyn.2020.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 11/20/2022]
Abstract
Neuraxial analgesia provides excellent pain relief in labor. Optimizing initiation and maintenance of neuraxial labor analgesia requires different strategies. Combined spinal-epidurals or dural puncture epidurals may offer advantages over traditional epidurals. Ultrasound is useful in certain patients. Maintenance of analgesia is best achieved with a background regimen (either programmed intermittent boluses or a continuous epidural infusion) supplemented with patient-controlled epidural analgesia and using dilute local anesthetics combined with opioids such as fentanyl. Nitrous oxide and systemic opioids are also used for pain relief. Nitrous oxide may improve satisfaction despite variable effects on pain. Systemic opioids can be administered by healthcare providers or using patient-controlled analgesia. Appropriate choice of drug should take into account the stage and progression of labor, local safety protocols, and maternal and fetal/neonatal side effects. Pain in labor is complex, and women should fully participate in the decision-making process before any one modality is selected.
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Affiliation(s)
- Jalal A Nanji
- Department of Anesthesiology and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive MC: 5640, Stanford, CA, 94305, USA.
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Lu YY, Cai JJ, Jin SW, Wang CH, Zhou YF, Hu MP, Li J. [Application of dural puncture epidural technique for labor analgesia]. Zhonghua Yi Xue Za Zhi 2020; 100:363-6. [PMID: 32074780 DOI: 10.3760/cma.j.issn.0376-2491.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of dural puncture epidural technique for labor analgesia on mothers and neonates. Methods: From January to June 2019, one hundred healthy and nulliparous women, scheduled for elective labor analgesia in the Second Affiliated Hospital of Wenzhou Medical University, met inclusion criteriaand were recruitedin this prospective study. The inclusion criteria are as follows: American Society of Anesthesiologists physical statusⅠorⅡ, New York Heart Association gradeⅠorⅡ,150-175 cm in height,50-90 kg in weight and 37-45 weeks of gestation. They were randomly divided into epidural analgesia group(group P, n=50)and dural puncture epidural group(group D, n=50) by using random number table. Parturients in group D received epidural catheterization immediate after successful epidural puncture, while parturients in group P received a single dural puncture into subarachnoid space with a 27 gauge needle (successful puncture: outflow of cerebrospinal fluid) before epidural catheterization. Epidural labor analgesia was performed with epidural infusion of 0.1% ropivacaine plus 0.25 μg/ml sufentanil in both groups. The VAS scores were evaluated at the following time points: before epidural infusion, each uterine contraction within 30 min after infusion, 30 min, 60 min and 90 min after infusion and withdrawal of infusion. Labor process, mode of delivery, cases of increased oxytocin using, effective PCA pressings, sufentanil and ropivacaine dosages, complications of analgesia, neonatal status were recorded, as well. Results: There were no significant differences in labor duration, mode of delivery, analgesia complications (nausea and vomiting, itching, headache after delivery and Bromage score for motor block), deceleration of fetal heart rate and neonatal Apgar score between the two groups (P>0.05). The number of effective PCA pressings, sufentanil dosage, ropivacaine dosage and cases of increased using of oxytocin were significantly more in group P(t=8.663,7.024,6.509,χ(2)=4.159,all P<0.05), with (8.6±2.5) times, (29±4) μg,(105±15) mg,28% in group P, compared with (4.6±2.1) times,(23±4) μg,(88±12) mg,10% in group D, respectively. The first four VAS scores of uterine contraction after analgesia in group P(VAS=7.9±1.1,6.8± 0.9, 5.6±0.8, 4.5±0.8)were significantly higher than those in group D (VAS=6.8±0.7,4.7±0.8,3.5±0.8,2.9±0.7,t=5.966,12.332,13.125,10.643,all P<0.05). The VAS scores at 90 min after analgesia and withdrawal of analgesia (VAS=2.7±0.6, 2.9±0.7) in group P were significantly higher than those in group D (VAS=2.4±0.6, 2.5±0.6, t=2.500, 3.068, all P<0.05). Conclusion: Compared with traditional epidural technique, dural puncture epidural technique can provide a rapid and effective analgesia with less analgesics, but without increasing adverse effects on mother and infant.
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Yang FP, Chao AS, Lin SH, Chao A, Wang TH, Chang YL, Chang HS, Wang JJ. Functional human brain connectivity during labor and its alteration under epidural analgesia. Brain Imaging Behav 2020; 14:2647-2658. [PMID: 31900889 DOI: 10.1007/s11682-019-00216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study used functional magnetic resonance imaging to explore the neural networks of pain during labor and its relief. It was hypothesized that epidural analgesia would affect the neural activities and the underlying network connectivity. Analysis using dynamic causal modelling and functional connectivity was performed to investigate the spatial activity and network connection of labor pain with and without epidural analgesia. This Institutional Review Board approved study acquired Magnetic Resonance Imaging from 15 healthy women of spontaneous normal delivery (with/without epidural analgesia = 7/8, aged 29.6 ± 2.3 and 29.3 ± 4.8 years old respectively) using a 1.5 Tesla scanner. Numerical rating score of pain was evaluated by a research nurse in the beginning of the first stage of labor and approximately 30 min after imaging examination. Six regions of interested from the activated clusters and literature were selected for dynamic causal modelling, which included primary and secondary somatosensory cortex, middle frontal gyrus, anterior cingulate cortex, insula and lentiform. Functional connectivity was calculated from selected sensory and affective regions. All analyses were performed by using software of statistical parametric mapping version 8 and CONN functional connectivity toolbox. The result showed that the experience of labor pain can lead to activations within a distributed brain network. The pain relief from epidural analgesia can be accompanied with altered functional connectivity, which was most evident in the cingulo-frontal system. The present study, therefore, provides an overview of a pain-related neural network that occur during labor and upon epidural analgesia.
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Affiliation(s)
- Fan-Pei Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Sung-Han Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan
| | - Anne Chao
- Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan City, Taiwan.
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Khaneshi R, Rasooli S, Moslemi F, Fakour S. Comparison of Continuous Epidural Infusion of Bupivacaine and Fentanyl Versus Patient Controlled Analgesia Techniques for Labor Analgesia: A Randomized Controlled Trial (RCT). J Reprod Infertil 2020; 21:42-8. [PMID: 32175264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND To diminish labor pain, several techniques have been used in developed countries. In the current randomized controlled trial, the use of epidural analgesia via PCEA pump with and without background infusion of analgesic was studied. METHODS In this double-blinded controlled trial, 60 women were enrolled and randomly assigned to study groups for receiving epidural analgesia during labor. All patients received initial bullous dose including 125 mg bupivacaine and 3 mg/ml fentanyl, and the first group patient (CI) received background infusion of 8 ml/hr and the second group (PCEA) received 10 ml bullous dose of 125 mg bupivacaine combined with 100 mcg fentanyl (2 ml) via epidural catheter. The Visual Analogue Scale (VAS) of 0-10 was measured 20 min after drug injection. The chi-square and student T-test were used for comparing variables between groups, and 0.05 was considered as the level of significance. RESULTS There was no significant difference in terms of demographic variables. Mean duration of the second stage of labor was significantly lower in patients received continuous infusion (CI) (p<0.0001). However, the total administered fentanyl dose was significantly higher in patients who underwent PCEA (p<0.0001). Besides, the CI group had a significantly lower rate of patient-controlled injection compared to PCEA patients (p<0.0001). However, there was no significant difference between patients' satisfaction and VAS in study groups. CONCLUSION Epidural analgesia using PCEA combined with continuous infusion did not provide higher analgesia or patients' satisfaction compared to PCEA alone; however, it led to a decreased rate of drug injection and total administered dosage.
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Alimoradi Z, Kazemi F, Valiani M, Gorji M. Comparing the effect of auricular acupressure and body acupressure on pain and duration of the first stage of labor: study protocol for a randomized controlled trial. Trials 2019; 20:766. [PMID: 31870458 PMCID: PMC6929442 DOI: 10.1186/s13063-019-3896-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Labor pain is one of the leading causes of fear of childbirth. Acupressure is a non-pharmacological pain relief method that has shown promising results in relieving this pain. The present study is designed to compare the effects of body acupressure at multiple points and auricular acupressure on the pain and duration of labor. METHODS/DESIGN In a randomized controlled trial, 90 primigravida women who attend for childbirth will be randomly assigned to one of three groups (intervention groups of either body acupressure or auricular acupressure; control, consisting of routine care). Computer-generated six-block randomization techniques will be used to determine the allocation sequence with a 1:1:1 ratio. To hide the allocation, the type of intervention will be written according to the generated sequence and put in opaque envelopes; these as well as questionnaires will be encoded. The pain score for all participants will be measured at the peak uterine contraction at 4-cm cervical dilation and at 10-cm dilation based on a visual analog scale (VAS). The duration of the active phase of labor in these groups will be recorded too. Data will be imported into SPSS-16 software. First, normality of the data distribution will be investigated. To compare labor duration among the research groups, ANOVA will be used, which will be followed, in case of significance, by the Scheffe post hoc test. Furthermore, Chi-squared test will be used to compare the categorized demographic variables and ANOVA or Kruskal-Wallis tests will be used to compare the quantitative variables in the studied groups. A significance level of 0.05 is considered significant. DISCUSSION In this study the effect of auricular acupressure and body acupressure on pain and duration of first stage of labor will be compared. TRIAL REGISTRATION Iranian Registry of Clinical Trials, IRCT20180218038789N1. Registered 2018-03-04; pre result.
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farideh Kazemi
- Department of midwifery, Mother & Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Science, Front of Mardom Park, Shahid Fahmideh blv., Hamadan, 65178-38698 Iran
| | - Mahboubeh Valiani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Gorji
- Velayat Clinical & Educational Hospital, Qazvin University of Medical Science, Qazvin, Iran
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Siyoum M, Mekonnen S. Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia. BMC Res Notes 2019; 12:619. [PMID: 31547839 PMCID: PMC6757368 DOI: 10.1186/s13104-019-4645-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/13/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess labor pain control and associated factors among women who give birth at Leku primary hospital, southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS). RESULTS In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24 year AOR = 5.85 (95% CI 2.14, 15.98), being farmer AOR = 2.5 (1.14, 5.57), primi-para AOR = 0.13 (0.06, 0.3), good family support AOR = 2.8 (1.49, 5.3), short duration of labor (< 12 h) AOR = 3.2 (1.65, 6.23) and history of pregnancy loss AOR = 0.06 (0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.
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Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, P.O. box 1560, Hawassa, Ethiopia.
| | - Shewangizaw Mekonnen
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, P.O. box 1560, Hawassa, Ethiopia
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Clara B, Paul V, Denis P, Stéphanie M, Hélène VR, Rémy B. Efficacy of phloroglucinol for the treatment of pain of gynaecologic or obstetrical origin: a systematic review of literature of randomised controlled trials. Eur J Clin Pharmacol 2020; 76:1-6. [PMID: 31435708 DOI: 10.1007/s00228-019-02745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Antispasmodics like phloroglucinol are commonly used to alleviate pain. Various authorities recommend the use of this drug for conditions such as dysmenorrhoea, threatened abortion or labour pains. The goal was to carry out a systematic review analysing the existing data concerning the efficacy of phloroglucinol to treat pain in obstetrical or gynaecologic cases. The protocol was registered in Prospero (CRD 42018094065). METHODS The keywords "phloroglucinol" and "randomised controlled trials" were used to search Medline, Embase and the Cochrane Library. We selected randomised, controlled against placebo trials testing the effect of phloroglucinol on gynaecologic or obstetrical pain either as a primary or secondary endpoint. We excluded trials exploring pain caused by intestinal, renal, metabolic or other causes and trials that were not available for critical review in either English or French. A quantitative synthesis (meta-analysis) was planned if the included trials were sufficiently homogenous. If this were not the case, a descriptive synthesis would be presented. RESULTS Twelve trials identified studied the effect of phloroglucinol in gynaecologic or obstetrical conditions. Only two trials corresponded to the inclusion criteria of this review, one of which was not available for critical review. CONCLUSIONS Phloroglucinol is not well evaluated in this field. Whether for labour pains, abortion pains or benign gynaecologic pains, the results found are insufficient to promote the use of this drug in these indications.
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Seringec Akkececi N, Oksuz G, Urfalioğlu A, Gunesacar R, Bakacak M, Arslan M, Kelleci BM. Preoperative Serum Leptin Level Is Associated with Preoperative Pain Threshold and Postoperative Analgesic Consumption in Patients Undergoing Cesarean Section. Med Princ Pract 2019; 28:333-340. [PMID: 31022717 PMCID: PMC6639575 DOI: 10.1159/000500556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/25/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the preoperative level of serum leptin in cesarean section (C-section) patients with and without acute labor pain and its association with postoperative analgesic consumption and preoperative pain threshold. MATERIALS AND METHODS Preoperative leptin levels, preoperative pain threshold, postoperative analgesic consumption in the first 24 h, and postoperative pain severity (visual analog scale (VAS) scores at 1, 2, 4, 6, 12, and 24 h postoperatively) in C-section patients with labor pain (emergency C-section; n = 21) and without labor pain (elective C-section; n = 25) were compared. RESULTS There were no significant differences between the groups regarding the demographic characteristics. Leptin levels, postoperative VAS scores, and analgesic consumption were significantly higher in the group with labor pain, while the preoperative pain threshold was lower. Serum leptin levels correlated negatively with pain threshold and positively with postoperative analgesic consumption. Multiple linear regression analyses in our study revealed that the preoperative leptin levels and having an emergency C-section independently affected the postoperative analgesic consumption and preoperative pain threshold, whereas their combined effects on these parameters were statistically not significant. CONCLUSION Preoperative levels of serum leptin were higher in C-section patients with labor pain than in those without labor pain, and increased serum leptin levels were associated with decreased preoperative pain threshold and increased postoperative analgesic consumption in our study population. Postoperative analgesic requirements may vary among patients, and their requirements might be predicted using preoperative indicators. Serum levels of leptin might be one such indicator and this warrants further studies with larger sample sizes.
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Affiliation(s)
- Nurten Seringec Akkececi
- Department of Physiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey,
| | - Gozen Oksuz
- Department of Anesthesia and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Aykut Urfalioğlu
- Department of Anesthesia and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ramazan Gunesacar
- Department of Medical Biology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Murat Bakacak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mahmut Arslan
- Department of Anesthesia and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Bekir Mehmet Kelleci
- Department of Medical Biology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Gunaydin B, Erel S. How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option. J Anesth 2019; 33:125-30. [PMID: 30293143 DOI: 10.1007/s00540-018-2564-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIM Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population. The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature DISCUSSION: Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural. CONCLUSION DPE offers a favorable risk-benefit ratio for management of neuraxial analgesia as a novel option.
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