Prospective randomized trials comparing intrathecal narcotics with epidural analgesia and no spinal analgesia
could substantially improve our understanding of the effects of spinal analgesia
on the course and outcomes of labor.
Small dose bupivacaine-fentanyl spinal analgesia
combined with morphine for labor.
Efficacy of spinal analgesia
on stages of labor 17 Shahrivar Hospital Mashhad.
Hesselgard (5,6) described up to 38 children (it is unclear whether some children are reported in both studies) under-going multiple level selective dorsal rhizotomy receiving either intermittent or continuous spinal analgesia
through surgically placed spinal catheters for five days postoperatively.
Key Words: spinal analgesia
, morphine, dilution, predilution
It is a general belief that in patients with spina bifida analgesia for labour and delivery can be associated with greater frequency of failure, accidental dural puncture and post-dural puncture headache (1,3,4) The use of continuous epidural, caudal and spinal analgesia
, paravertebral sympathetic and paracervical blocks and intravenous patient-controlled analgesia have been reported in pregnant women with spina bifida; however, all of these techniques have been associated with a number of limitations (e.g., technical difficulty, excessive cranial/poor perineal spread of local anaesthetics and/or asymmetric block) and complications (e.g., dural puncture) (1,3,4).
The longer duration of spinal analgesia
can be attributed to higher age group in their study leading to longer time to first analgesic (3.7 [+ or -] 2.3 hours) compared to the present study (92.1 [+ or -] 62.2 minutes).
First spinal analgesia
using a 26G Quincke's needle with fentanyl 15mcg diluted to 0.5ml with sterile saline was given and needle withdrawn.
The duration of spinal analgesia
can be prolonged by the adjuvants like vasoconstrictors, opioids, neostigmine, ketamine, midazolam, etc.
Caudal epidural anesthesia first described by Cathelin and Sicard in Paris in 19016 At first they attempted to produce block of spinal nerves that would improve on spinal analgesia
in laboratory animals.
However duration of spinal analgesia
by bupivacaine is limited upto 75-150 min.
(6.) Jonnesco T 1909 Remarks on general spinal analgesia
. Br Med J 2: 1396-401.