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[PMID]: 29049122 [Au] Autor: Leighton BL; Crock LW [Ad] Endereço: From the *Department of Surgery, Garrett Regional Medical Center, Oakland, Maryland; and †Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri. [Ti] Título: Case Series of Successful Postoperative Pain Management in Buprenorphine Maintenance Therapy Patients. [So] Source: Anesth Analg;125(5):1779-1783, 2017 Nov. [Is] ISSN: 1526-7598 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Buprenorphine maintenance therapy patients frequently have severe postoperative pain due to buprenorphine-induced hyperalgesia and provider use of opioids with limited efficacy in the presence of buprenorphine. The authors report good-to-excellent pain management in 4 obstetric patients using nonopioid analgesics, regional anesthesia, continuation of buprenorphine, and use of opioids with high µ receptor affinity. [Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem Combinação Buprenorfina e Naloxona/administração & dosagem Recesariana/efeitos adversos Antagonistas de Entorpecentes/administração & dosagem Tratamento de Substituição de Opiáceos/métodos Transtornos Relacionados ao Uso de Opioides/reabilitação Manejo da Dor/métodos Dor Pós-Operatória/prevenção & controle Esterilização Tubária/efeitos adversos [Mh] Termos MeSH secundário: Adulto Analgesia Obstétrica Analgesia Controlada pelo Paciente Analgésicos não Entorpecentes/administração & dosagem Analgésicos Opioides/efeitos adversos Anestésicos Locais/administração & dosagem Combinação Buprenorfina e Naloxona/efeitos adversos Esquema de Medicação Feminino Seres Humanos Antagonistas de Entorpecentes/efeitos adversos Tratamento de Substituição de Opiáceos/efeitos adversos Transtornos Relacionados ao Uso de Opioides/diagnóstico Transtornos Relacionados ao Uso de Opioides/fisiopatologia Transtornos Relacionados ao Uso de Opioides/psicologia Manejo da Dor/efeitos adversos Medição da Dor Percepção da Dor/efeitos dos fármacos Limiar da Dor/efeitos dos fármacos Dor Pós-Operatória/diagnóstico Dor Pós-Operatória/fisiopatologia Dor Pós-Operatória/psicologia Gravidez Resultado do Tratamento Adulto Jovem [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Buprenorphine, Naloxone Drug Combination); 0 (Narcotic Antagonists) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171030 [Lr] Data última revisão: 171030 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171020 [St] Status: MEDLINE [do] DOI: 10.1213/ANE.0000000000002498

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[PMID]: 29046273 [Au] Autor: Epidural and Position Trial Collaborative Group [Ti] Título: Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. [So] Source: BMJ;359:j4471, 2017 Oct 18. [Is] ISSN: 1756-1833 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo:  To determine whether being upright in the second stage of labour in nulliparous women with a low dose epidural increases the chance of spontaneous vaginal birth compared with lying down. Multicentre pragmatic individually randomised controlled trial. 41 UK hospital labour wards. 3093 nulliparous women aged 16 or older, at term with a singleton cephalic presentation and in the second stage of labour with epidural analgesia. Women were allocated to an upright or lying down position, using a secure web based randomisation service, stratified by centre, with no masking of participants or clinicians to the trial interventions. The primary outcome was spontaneous vaginal birth. Women were analysed in the groups into which they were randomly allocated, regardless of position recorded at any time during the second stage of labour (excluding women with no valid consent, who withdrew, or who did not reach second stage before delivery). Secondary outcomes included mode of birth, perineal trauma, infant Apgar score <4 at five minutes, admission to a neonatal unit, and longer term included maternal physical and psychological health, incontinence, and infant gross developmental delay.  Between 4 October 2010 and 31 January 2014, 3236 women were randomised and 3093 (95.6%) included in the primary analysis (1556 in the upright group and 1537 in the lying down group). Significantly fewer spontaneous vaginal births occurred in women in the upright group: 35.2% (548/1556) compared with 41.1% (632/1537) in the lying down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). This represents a 5.9% absolute increase in the chance of spontaneous vaginal birth in the lying down group (number needed to treat 17, 95% confidence interval 11 to 40). No evidence of differences was found for most of the secondary maternal, neonatal, or longer term outcomes including instrumental vaginal delivery (adjusted risk ratio 1.08, 99% confidence interval 0.99 to 1.18), obstetric anal sphincter injury (1.27, 0.88 to 1.84), infant Apgar score <4 at five minutes (0.66, 0.06 to 6.88), and maternal faecal incontinence at one year (1.18, 0.61 to 2.28). Evidence shows that lying down in the second stage of labour results in more spontaneous vaginal births in nulliparous women with epidural analgesia, with no apparent disadvantages in relation to short or longer term outcomes for mother or baby. Current Controlled Trials ISRCTN35706297. [Mh] Termos MeSH primário: Analgesia Obstétrica/métodos Anestesia Epidural/métodos Anestésicos/administração & dosagem Segunda Fase do Trabalho de Parto/fisiologia Efeitos Adversos de Longa Duração/prevenção & controle Complicações do Trabalho de Parto/prevenção & controle Posicionamento do Paciente/métodos [Mh] Termos MeSH secundário: Adulto Índice de Apgar Relação Dose-Resposta a Droga Feminino Seres Humanos Recém-Nascido Trabalho de Parto/fisiologia Efeitos Adversos de Longa Duração/diagnóstico Efeitos Adversos de Longa Duração/etiologia Complicações do Trabalho de Parto/diagnóstico Complicações do Trabalho de Parto/etiologia Paridade/fisiologia Gravidez Resultado da Gravidez Reino Unido [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171026 [Lr] Data última revisão: 171026 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171020 [St] Status: MEDLINE [do] DOI: 10.1136/bmj.j4471

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[PMID]: 29016499 [Au] Autor: Shen X; Li Y; Xu S; Wang N; Fan S; Qin X; Zhou C; Hess PE [Ad] Endereço: Departments of Anesthesiology and Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; and the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. [Ti] Título: Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial. [So] Source: Obstet Gynecol;130(5):1097-1103, 2017 Nov. [Is] ISSN: 1873-233X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.08% ropivacaine with 0.4 micrograms/mL sufentanil with patient-controlled epidural analgesia. At the onset of the second stage of labor, women were randomized to receive a blinded infusion of the same solution or placebo saline infusion. The primary outcome was the duration of the second stage of labor. A sample size of 200 per group (400 total) was planned to identify at least a 15% difference in duration. RESULTS: Between March 2015 and September 2015, 560 patients were screened and 400 patients (200 in each group) completed the study. Using an intention-to-treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52). The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17). Pain scores were similar between groups at each measurement during the second stage. More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001). CONCLUSION: Maintaining the infusion of epidural medication had no effect on the duration of the second stage of labor compared with a placebo infusion. Maternal and neonatal outcomes were similar. A low concentration of epidural local anesthetic does not affect the duration of the second stage of labor. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Register, http://www.chictr.org.cn/enindex.aspx, ChiCTR-IOR-15005875. [Mh] Termos MeSH primário: Analgesia Epidural/métodos Analgesia Obstétrica/métodos Analgésicos/administração & dosagem Dor do Parto/tratamento farmacológico Segunda Fase do Trabalho de Parto/efeitos dos fármacos [Mh] Termos MeSH secundário: Amidas/administração & dosagem Método Duplo-Cego Feminino Seres Humanos Gravidez Sufentanil/administração & dosagem Fatores de Tempo Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Amides); 0 (Analgesics); 7IO5LYA57N (ropivacaine); AFE2YW0IIZ (Sufentanil) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171102 [Lr] Data última revisão: 171102 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171011 [St] Status: MEDLINE [do] DOI: 10.1097/AOG.0000000000002306

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[PMID]: 28926443 [Au] Autor: Komatsu R; Carvalho B; Flood PD [Ad] Endereço: From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California. [Ti] Título: Recovery after Nulliparous Birth: A Detailed Analysis of Pain Analgesia and Recovery of Function. [So] Source: Anesthesiology;127(4):684-694, 2017 Oct. [Is] ISSN: 1528-1175 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients. METHODS: A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery. The primary endpoint, pain- and opioid-free functional recovery, was the time required to reach all three of the endpoints. Pain burden was assessed as the area under the curve created by plotting the daily numerical pain rating scale against the days required to attain pain resolution. Times to attain study endpoints after cesarean delivery and vaginal delivery were compared using survival analysis. RESULTS: After vaginal delivery, days required for pain and opioid-free functional recovery (median [interquartile range (IQR)]) were 19 [11 to 26], for opioid cessation 0 [0 to 2], termination of all analgesic (including nonsteroidal antiinflammatories and acetaminophen) 11 [5 to 17], and pain resolution 14 [7 to 24]. Achievement of these endpoints after cesarean delivery required 27 [19 to 40], 9 [5 to 12], 16 [11 to 24], and 21 [14 to 27] days, respectively. CONCLUSIONS: There is clinically significant variability between healthy nulliparous parturients in the pain experience, opioid use, and functional recovery after childbirth following vaginal and cesarean delivery. Recovery to predelivery function is similar after vaginal and cesarean delivery, and approximately half of the variance was explained by pain burden. [Mh] Termos MeSH primário: Analgesia Obstétrica/métodos Analgésicos Opioides/uso terapêutico Parto Obstétrico/métodos Dor/tratamento farmacológico Parto/fisiologia Recuperação de Função Fisiológica/fisiologia [Mh] Termos MeSH secundário: Adulto Feminino Seres Humanos Paridade Período Pós-Parto Gravidez Estudos Prospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Nm] Nome de substância: 0 (Analgesics, Opioid) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171027 [Lr] Data última revisão: 171027 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170920 [St] Status: MEDLINE [do] DOI: 10.1097/ALN.0000000000001789

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[PMID]: 28926440 [Au] Autor: Lee AI; McCarthy RJ; Toledo P; Jones MJ; White N; Wong CA [Ad] Endereço: From the Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, Texas (A.I.L.); Department of Anesthesiology (R.J.M., P.T., M.J.J.) and Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois (R.J.M., P.T.); Department of Nursing, Northwestern Memorial Hospital Chicago, Illinois (N.W.); and Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.). [Ti] Título: Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial. [So] Source: Anesthesiology;127(4):614-624, 2017 Oct. [Is] ISSN: 1528-1175 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. METHODS: The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 µg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 µg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. RESULTS: A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 µg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 µg [95% CI of the difference, -58 to 79 µg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. CONCLUSIONS: Labor epidural solutions containing fentanyl concentrations as high as 2 µg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum. [Mh] Termos MeSH primário: Analgesia Epidural/métodos Analgesia Obstétrica/métodos Analgésicos Opioides Aleitamento Materno/estatística & dados numéricos Fentanila Trabalho de Parto [Mh] Termos MeSH secundário: Adulto Relação Dose-Resposta a Droga Método Duplo-Cego Feminino Seres Humanos Gravidez [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Analgesics, Opioid); UF599785JZ (Fentanyl) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171003 [Lr] Data última revisão: 171003 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170920 [St] Status: MEDLINE [do] DOI: 10.1097/ALN.0000000000001793

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[PMID]: 28708666 [Au] Autor: Kantor E; Guglielminotti J; Azria E; Luton D; Laurent M; Oury JF; Mahieu-Caputo D; Ravaud P; Estellat C; PreCARE Study Group [Ad] Endereço: From the *Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique (CIC) 1425-Epidémiologie Clinique (EC), UMR 1123, Paris, France; ‡Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France; §INSERM, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France; ‖INSERM, UMR 1153, Équipe de Recherche en épidémiologie Obstétricale Périnatale et Pédiatrique, Université Paris Descartes, Paris, France; ¶Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, Paris, France; #Service de Gynécologie-Obstétrique, Hôpital Beaujon, AP-HP, Clichy, France; **Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Colombes, France; ††Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France; ‡‡Service de Gynécologie-Obstétrique, Hôpital Bichat, AP-HP, Paris, France; §§Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; ‖‖Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Université Paris Descartes, Paris, France; ¶¶Centre de Pharmaco-épidémiologie de l'AP-HP, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris France; and ##INSERM, UMR 1123 Epidémiologie Clinique et évaluation économique Appliquées aux Populations Vulnérables, Paris, France. [Ti] Título: Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study. [So] Source: Anesth Analg;125(3):925-933, 2017 Sep. [Is] ISSN: 1526-7598 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor. METHODS: Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics. RESULTS: Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540). CONCLUSIONS: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation. [Mh] Termos MeSH primário: Anestesia Obstétrica/economia Anestesia Obstétrica/utilização Parto Obstétrico/economia Manejo da Dor/economia Manejo da Dor/utilização Classe Social [Mh] Termos MeSH secundário: Analgesia Obstétrica/economia Analgesia Obstétrica/utilização Estudos de Coortes Feminino França/epidemiologia Seres Humanos Gravidez Estudos Prospectivos Estudos Retrospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170907 [Lr] Data última revisão: 170907 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170715 [St] Status: MEDLINE [do] DOI: 10.1213/ANE.0000000000002275

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[PMID]: 28659122 [Au] Autor: Zhou D; Gong H; He S; Gao W; Wang Q [Ad] Endereço: Department of Anesthesiology, The Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, 710061, China. [Ti] Título: Effects of combined spinal epidural labor analgesia on episiotomy: a retrospective cohort study. [So] Source: BMC Anesthesiol;17(1):88, 2017 Jun 28. [Is] ISSN: 1471-2253 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: According to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery. However, its effects on episiotomy are unknown. This study aimed to examine the incidence of episiotomy with and without combined spinal-epidural analgesia (CSEA) during labor. METHODS: This was a retrospective cohort study, in which the computerized medical records of nulliparous women with singleton, cephalic and live births were reviewed and women with and without CSEA were matched based on their propensity scores. Univariate and multivariate analyses were used to examine the association between CSEA and the incidence of episiotomy during vaginal delivery. RESULTS: In the cohort study with 11,994 vaginal deliveries, 5748 received CSEA and 6246 did not receive CSEA. 4116 CSEA women were successfully matched with 4116 Non-CSEA women. In the univariate analysis, the incidence of episiotomy was 47.4% in the CSEA group and 44.7% in the Non-CSEA group. However, after a multivariable logistic regression analysis, CSEA did not increase the risk of episiotomy (adjusted OR, 1.080; 95% confidence interval [CI], 0.988-1.180). CONCLUSIONS: The use of CSEA during labor and vaginal delivery did not increase the risk of episiotomy. [Mh] Termos MeSH primário: Analgesia Epidural Analgesia Obstétrica Raquianestesia Episiotomia/estatística & dados numéricos [Mh] Termos MeSH secundário: Adulto Estudos de Casos e Controles Estudos de Coortes Feminino Seres Humanos Análise Multivariada Gravidez Estudos Retrospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171107 [Lr] Data última revisão: 171107 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170630 [St] Status: MEDLINE [do] DOI: 10.1186/s12871-017-0381-8

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[PMID]: 28625307 [Au] Autor: Carvalho B; Butwick AJ [Ad] Endereço: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: bcarvalho@stanford.edu. [Ti] Título: Postcesarean delivery analgesia. [So] Source: Best Pract Res Clin Anaesthesiol;31(1):69-79, 2017 Mar. [Is] ISSN: 1878-1608 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: Effective pain management should be a key priority in women undergoing cesarean delivery. Suboptimal perioperative pain management is associated with chronic pain, greater opioid use, delayed functional recovery, impaired maternal-fetal bonding, and increased postpartum depression. Severe acute postoperative pain is also strongly associated with persistent pain after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery pain management. The use of neuraxial morphine and opioid-sparing adjuncts such as scheduled nonsteroidal anti-inflammatory medications and acetaminophen is recommended for all women undergoing cesarean delivery with neuraxial anesthesia unless contraindicated. Additional analgesic and opioid-sparing options such as wound instillation of local anesthetics, transversus abdominis plane blocks, dexamethasone, gabapentin, and ketamine may be used as appropriate in women at risk of severe postoperative pain or in women whose postoperative pain is not well controlled despite standard analgesic regimes. [Mh] Termos MeSH primário: Analgesia Obstétrica/métodos Cesárea/efeitos adversos Dor Pós-Operatória/tratamento farmacológico [Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico Analgesia Analgésicos não Entorpecentes/uso terapêutico Analgésicos Opioides/uso terapêutico Anestésicos Locais Anti-Inflamatórios não Esteroides/uso terapêutico Feminino Seres Humanos Gravidez [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Anti-Inflammatory Agents, Non-Steroidal); 362O9ITL9D (Acetaminophen) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171107 [Lr] Data última revisão: 171107 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170620 [St] Status: MEDLINE

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[PMID]: 28625303 [Au] Autor: Phillips SN; Fernando R; Girard T [Ad] Endereço: University College Hospitals London, Department of Anaesthesia and Perioperative Medicine, Maple Link Corridor, Podium Level 3, 235 Euston Road, London NW1 2BU, UK. Electronic address: Sioned.phillips@doctors.org.uk. [Ti] Título: Parenteral opioid analgesia: Does it still have a role? [So] Source: Best Pract Res Clin Anaesthesiol;31(1):3-14, 2017 Mar. [Is] ISSN: 1878-1608 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: Parenteral opioids have been used in labour analgesia for many years, but the ideal opioid in this setting is yet to be found. We review the properties of currently used opioids, their analgesic properties and side effects to mother and foetus. Parenteral opioids can be administered as intermittent boluses or through a patient-controlled intravenous administration system. A wide range of opioid drugs are currently used and provide a variable degree of analgesia. All opioids can cause unwanted maternal side effects such as nausea, vomiting, sedation and respiratory depression. They cross the placenta and have the potential to cause neonatal respiratory depression. Remifentanil patient-controlled intravenous analgesia is becoming increasingly available and popular on some delivery suites. It can provide adequate analgesia and is useful when epidural analgesia is contraindicated. Remifentanil patient-controlled analgesia requires close monitoring in an environment familiar with the technique to avoid maternal hypoxia due to respiratory depression. [Mh] Termos MeSH primário: Analgesia Epidural Analgesia Obstétrica Analgesia Controlada pelo Paciente Analgésicos Opioides Manejo da Dor/métodos [Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem Analgésicos Opioides/efeitos adversos Analgésicos Opioides/farmacocinética Feminino Feto/efeitos dos fármacos Seres Humanos Placenta/metabolismo Gravidez [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Analgesics, Opioid) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171107 [Lr] Data última revisão: 171107 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170620 [St] Status: MEDLINE

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[PMID]: 28625301 [Au] Autor: Sng BL; Sia ATH [Ad] Endereço: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore. Electronic address: sng.ban.leong@singhealth.com.sg. [Ti] Título: Maintenance of epidural labour analgesia: The old, the new and the future. [So] Source: Best Pract Res Clin Anaesthesiol;31(1):15-22, 2017 Mar. [Is] ISSN: 1878-1608 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: Neuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia. We also review the newer interactive techniques for drug delivery, such as computer-integrated patient-controlled epidural analgesia and variable frequency automated mandatory bolus. Finally, we discuss future clinical research developments, including the use of data analytics and long-term outcomes associated with childbirth pain management. [Mh] Termos MeSH primário: Analgesia Epidural/tendências Analgesia Obstétrica/tendências Dor do Parto/tratamento farmacológico Trabalho de Parto [Mh] Termos MeSH secundário: Analgesia Obstétrica/métodos Analgesia Controlada pelo Paciente/métodos Analgesia Controlada pelo Paciente/tendências Feminino Seres Humanos Gravidez [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171107 [Lr] Data última revisão: 171107 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170620 [St] Status: MEDLINE

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