epidural analgesia การใช้

• Charles B . Odom introduced lumbar epidural analgesia to obstetrics in 1935.
• In labouring women, the onset of analgesia is more rapid with CSE compared with epidural analgesia.
• The occurrence of prolonged postoperative mechanical ventilation and myocardial infarction is also reduced by epidural analgesia.
• Evidence to support the assertion that epidural analgesia increases the risk of anastomotic breakdown following bowel surgery is lacking.
• Regarding early or late administration of epidural analgesia, there is no overall difference in outcomes for first-time mothers in labor.
• As such, it has been used for analgesia in labor successfully; however, it is not as effective as epidural analgesia.
• The patient may also receive thoracic epidural analgesia in the back for two to five days depending on patient recovery.
• CSE in labouring women is associated with more pruritus if fentanyl ( 25?g ) is given intrathecally, than low-dose epidural analgesia.
• Some people have also been concerned about whether the use of epidural analgesia in early labour increases the risk of cesarean delivery.
• If this were the case, then early epidural analgesia which avoided the need for pethidine would be expected to improve breastfeeding outcomes rather than worsen them.
• CSE in labour was formerly thought to enable women to mobilise for longer compared with epidural analgesia, but this is not supported by a recent Cochrane review.
• To provide continuous epidural analgesia or anesthesia, a small hollow catheter may be threaded through the epidural needle into the epidural space, and left there while the needle is removed.
• Epidural analgesia does increase the duration of the second stage of labour by 15 to 30 minutes and may increase the rate of instrument-assisted vaginal deliveries as well as that of oxytocin administration.
• This prompted him to devise a now routinely administered continuous epidural analgesia that affects the nerves leading to the chest and lower half of the body, numbing the woman's pain without her losing consciousness.
• Three randomized, controlled trials showed that early initiation of epidural analgesia ( cervical dilatation, < 4 cm ) does not increase the rate of cesarean delivery among women with spontaneous or induced labour, as compared with early initiation of analgesia with parenteral opioids.
• "These results highlight the importance of reducing or eliminating the use of these agents, especially in U . S . hospitals, where epidural analgesia use during labor has become almost routine, " say John Kennell and Susan McGrath of the Rainbow Babies and Children's Hospital in Cleveland, Ohio.
• Finally, invasive procedures completed by the cardiothoracic anesthesiology fellows include but are not limited to arterial line placement ( femoral, axillary, brachial, radial ), central venous cannulation ( internal juggular, femoral, subclavian ), pulmonary artery catheter placement, transvenous pacemaker placement, thoracic epidural analgesia, fiberoptic endotracheal tube placement, 2D / 3D transesophageal echocardiography, intraspinal drainage placement, and advanced ultrasound guidance of vascular access.