Abstract：
BACKGROUND:Ketamine at subanesthetic doses has analgesic properties that have been shown to reduce postoperative pain and morphine consumption. We hypothesized that intravenous ketamine 10mg administered during spinal anesthesia for cesarean delivery, in addition to intrathecal morphine and intravenous ketorolac, would decrease the incidence of breakthrough pain and need for supplemental postoperative analgesia. METHODS:Using a randomized double-blind placebo-controlled design, healthy women scheduled for cesarean delivery receiving hyperbaric spinal bupivacaine, fentanyl and morphine were randomized to intravenous ketamine 10mg or saline following delivery. Postoperative analgesia included scheduled ketorolac and acetaminophen/hydrocodone tablets as needed for breakthrough pain. The primary outcome was the incidence of breakthrough pain in the first 24h. Secondary outcomes included the number of acetaminophen/hydrocodone tablets administered and numeric rating scale for pain (0-10). RESULTS:Group characteristics did not differ. There was no difference in the incidence of breakthrough pain (ketamine 75% VS. saline 74%, P=0.86). There was no difference in 24-h or 72-h use of supplemental acetaminophen/hydrocodone tablets between groups. Pain scores in the first 24h were similar, but lower in the ketamine compared to the saline group 2weeks postpartum (difference -0.6, 95% CI -1.1 to -0.9). CONCLUSIONS:We found no additional postoperative analgesic benefit of low-dose ketamine during cesarean delivery in patients who received intrathecal morphine and intravenous ketorolac. Subjects who received ketamine reported lower pain scores 2weeks postpartum.
journal_name
Int J Obstet Anesthjournal_title
International journal of obstetric anesthesiaauthors
Bauchat JR,Higgins N,Wojciechowski KG,McCarthy RJ,Toledo P,Wong CAdoi
10.1016/j.ijoa.2010.10.002subject
Has Abstractpub_date
2011-01-01 00:00:00pages
3-9issue
1eissn
0959-289Xissn
1532-3374pii
S0959-289X(10)00162-7journal_volume
20pub_type
杂志文章,随机对照试验abstract：BACKGROUND:China has one of the highest rates of caesarean delivery in the world. The aim of this study was to investigate the incidence and risk factors for chronic pain after caesarean delivery in a Chinese cohort. METHODS:Patients undergoing elective caesarean delivery with a Pfannenstiel incision under spinal anae...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2018.01.009
更新日期：2018-05-01 00:00:00
abstract：:We present our own single-space method for performing combined spinal epidural anaesthesia. A spinal introducer and a Tuohy needle are sited in the same interspace. After insertion of the epidural catheter the introducer is used as a guide for a 25 gauge spinal needle. The advantages of this technique over other metho...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(95)82972-d
更新日期：1995-07-01 00:00:00
abstract：:We report the management of a morbidly obese parturient suffering from narcolepsy with cataplexy who presented for caesarean section. Her symptoms were controlled by modafinil and fluoxetine. We administered epidural anaesthesia successfully; surgery was uneventful and recovery was uncomplicated. We discuss some of th...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2010.07.015
更新日期：2010-10-01 00:00:00
abstract：:A case is described of a 30-year-old insulin-dependent diabetic woman who presented at 25 weeks gestation with frontal headache. Contrast tomography revealed an aneurysm of the middle cerebral artery with no evidence of subarachnoid bleeding. Although elective caesarean section at term was planned, it was performed at...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(93)90031-c
更新日期：1993-01-01 00:00:00
abstract：:Rupture of an aneurysm of the renal or splenic arteries remains a rare but catastrophic complication of pregnancy with a generally dismal prognosis for both mother and fetus. Improvements in abdominal imaging for incidental conditions are unlikely to lead to earlier diagnosis of such abnormalities antenatally, hence c...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/S0959-289X(02)00187-5
更新日期：2003-04-01 00:00:00
abstract：:A 30-year-old woman was admitted to the labour ward at term complaining of symptoms suggestive of raised intracranial pressure which were overlooked. Epidural analgesia was administered following induction of labour and was associated with a clear exacerbation of symptoms. After delivery a CT scan revealed a large cer...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(95)83004-2
更新日期：1995-04-01 00:00:00
abstract：:Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesopha...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2013.10.006
更新日期：2014-02-01 00:00:00
abstract：:A 70 kg, 34-year-old woman at 29 weeks-of-gestation required intrauterine transfusion for Rh (D) alloimmunization. In the ambulatory treatment clinic, 19 mg of rocuronium was administered intramuscularly in split doses into the fetal buttock. The fetus moved and inadvertent maternal neuromuscular blockade occurred, le...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2019.01.002
更新日期：2019-08-01 00:00:00
abstract：:We present two cases of neurovascular disease in pregnancy in which transcranial Doppler was used to assess the status of the cerebral circulation during cesarean section under regional anesthesia. One woman had been found to have moyamoya disease, following a series of transient ischemic attacks during her first preg...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.2002.0947
更新日期：2002-07-01 00:00:00
abstract：:The aim of the 2012 "What's new in obstetric anesthesia?" review is to highlight important scientific and medical advances in the fields of obstetric anesthesiology, obstetrics and perinatology from literature published in 2011. This review will consider advances in the prevention and treatment of important obstetric ...
journal_title：International journal of obstetric anesthesia
pub_type：
doi：10.1016/j.ijoa.2012.08.005
更新日期：2012-10-01 00:00:00
abstract：:This study explores which concentrations of local anesthetics might be expected to inhibit the growth of Staphylococcus aureus. Serial dilutions were made of 0.5% and 0.75% bupivacaine, 2% and 5% lidocaine, 2% and 3% chloroprocaine, and 0.2% and 1% ropivacaine. To each concentration of local anesthetic solution, Muell...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.2001.0934
更新日期：2002-04-01 00:00:00
abstract：BACKGROUND:We investigated the correlation between lumbar epidural analgesia onset time and pain intensity at 60 and 120 min after initiation. METHODS:We conducted a prospective observational study of nulliparous women receiving lumbar epidural analgesia (initial bolus 15 mL bupivacaine 0.1% with fentanyl 3.33 μg/mL),...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2019.05.008
更新日期：2019-11-01 00:00:00
abstract：BACKGROUND:Clinically overt infections of the epidural catheter skin entry site occur in approximately 1-5% of patients after a few days of catheterization but serious complications such as deep tissue infection or epidural abscess appear rare in the obstetric population. In recent years, sporadic reports and small ser...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.06.001
更新日期：2010-01-01 00:00:00
abstract：:Intracranial subdural hematoma is an exceptionally rare but life-threatening complication of spinal anesthesia. We report a case of intracranial subdural hematoma following spinal anesthesia for cesarean section in a 27-year-old woman. She developed a diffuse headache after surgery with a blood pressure of 220/140 mm ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2004.08.005
更新日期：2005-04-01 00:00:00
abstract：BACKGROUND:A common polymorphism of the μ-opioid receptor gene (OPRM1, p.118A/G), which has been shown to effect the response to neuraxial opioids, occurs in 30% of Caucasian women. This double-blind up-down sequential allocation study was designed to examine the effect of p.118A/G on the ED50 of epidural sufentanil fo...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2011.10.001
更新日期：2012-01-01 00:00:00
abstract：BACKGROUND:Early studies suggested that ropivacaine had clinical advantages over bupivacaine with respect to cardiotoxicity and motor block, and that it was suitable for epidural caesarean section. This study was set up to compare epidural 0.75% ropivacaine with a popular bupivacaine/fentanyl mixture for elective caesa...
journal_title：International journal of obstetric anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/j.ijoa.2005.01.002
更新日期：2005-07-01 00:00:00
abstract：:Pre-existing epidural analgesia was rapidly extended in 36 consecutive patients presenting for emergency caesarean section by using 20 ml of 2% lignocaine + 1/200,000 adrenaline freshly prepared given by slow bolus injection. Despite a wide range of initial analgesic sensory levels the technique produced blocks that w...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(91)90024-k
更新日期：1991-09-01 00:00:00
abstract：:HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardia...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2012.04.007
更新日期：2012-07-01 00:00:00
abstract：:We report the successful management of labor and delivery of a parturient with a history of spontaneous bilateral vertebral artery dissection. We also outline the reasons why the obstetric anesthetist should be aware of this condition as well as other cranio-cervical dissections. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/S0959-289X(03)00069-4
更新日期：2004-01-01 00:00:00
abstract：BACKGROUND:Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. We therefore studied th...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2009.08.007
更新日期：2010-04-01 00:00:00
abstract：:The past two decades has seen a growing understanding that health care leads to harm in a large number of patients. With this insight has come an understanding that clinicians who care for patients who are harmed experience an understandable and predictable emotional response. After an adverse event, medical care give...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2014.10.001
更新日期：2015-02-01 00:00:00
abstract：:Varicella (chicken pox) infection is associated with a significant risk of maternal and fetal morbidity and mortality. The choice of anesthetic technique, either neuraxial or general anesthesia, in such patients remains controversial. Anesthetic management depends not only on the extent of disease involvement and asso...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2016.06.002
更新日期：2016-12-01 00:00:00
abstract：:Blood pressure monitoring is a critical component of antenatal, peripartum and postnatal care. The accurate detection and treatment of abnormal blood pressure during pregnancy is essential for the optimisation of maternal and neonatal outcomes. Increasing maternal obesity in western populations is well documented. The...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2018.04.004
更新日期：2018-08-01 00:00:00
abstract：BACKGROUND:Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lid...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2006.09.006
更新日期：2007-04-01 00:00:00
abstract：BACKGROUND:Limited information exists on obstetric anesthesia experience and training within residency training programs in the United States. METHODS:A survey was sent to every academic anesthesiology training program in the United States (n=120), with follow-up reminders to non-responders. The survey included 14 que...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2006.04.013
更新日期：2006-10-01 00:00:00
abstract：:The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. One woman received an epidural blood patch, the other did not, but both suffered with chronic headaches following discharge from hospital. Neither woman was adequately f...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2018.12.006
更新日期：2019-05-01 00:00:00
abstract：:Current pain and analgesic management strategies apply a standardized one-size-fits-all approach to women undergoing cesarean delivery. These standardized protocols do not account for significant variability in women's pain and may lead to under-treatment in patients with high analgesic needs and overtreatment, associ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2019.02.124
更新日期：2019-11-01 00:00:00
abstract：:Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare but probably under-diagnosed disorder of peripheral nerves in which individuals suffer from repeated motor and sensory neuropathies (pressure palsies) following brief nerve compression or mild trauma. A seemingly trivial insult such as sitting or ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.2000.0828
更新日期：2001-07-01 00:00:00
abstract：:The pressor response is known to be exaggerated in patients with pregnancy-induced hypertension, which can result in increased morbidity and mortality in both mother and newborn. Various pharmacological agents have been used before induction in an attempt to attenuate the adrenergic response but with varying degree of...
journal_title：International journal of obstetric anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1054/ijoa.2001.0918
更新日期：2002-01-01 00:00:00
abstract：BACKGROUND:Failed intubation is relatively common in the obstetric patient. Overall, there has been a decline in experience of general anaesthesia in obstetrics. The level of anaesthetic preparedness in the event of a difficult obstetric intubation is unknown. METHODS:With approval from the Obstetric Anaesthetists' As...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.01.015
更新日期：2009-10-01 00:00:00
