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Spinal analgesia

Whittle ED

Malaya Medical Journal, 1911;9:15-20.

Matched MeSH terms: Analgesia
Letter to: Local anaesthesia for haemorrhoidal rubber band ligation reduces immediate post-operative recovery time and use of opioid analgesia

Hayati F, Che Ani MF, Syed Abdul Rahim SS, Andee Dzulkarnaen Zakaria, D' Souza UJA

ANZ J Surg, 2020 06;90(6):1217.
PMID: 32592306 DOI: 10.1111/ans.15920
Matched MeSH terms: Analgesia*; Analgesics, Opioid
Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur

Chan YK, Ng KP, Chiu CL

Int J Obstet Anesth, 2002 Jul;11(3):176-9.
PMID: 15321544 DOI: 10.1054/ijoa.2002.0954

Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. There was a decline in the use of general anaesthesia for both elective and emergency caesarean sections from 41.3% and 69.4% respectively in 1995 to 21.6% and 26.9% respectively in 1999. By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.

Matched MeSH terms: Analgesia*
Erector spinae plane block: inexplicable benefits in acute gastrointestinal injury

Sethuraman RM, Suresh V

Intensive Care Med, 2023 May;49(5):602-603.
PMID: 36964215 DOI: 10.1007/s00134-023-07030-x
Matched MeSH terms: Analgesia*
Epidural analgesia in primigravidae in spontaneous labour at term: a prospective study

Leong EW, Sivanesaratnam V, Oh LL, Chan YK

J Obstet Gynaecol Res, 2000 Aug;26(4):271-5.
PMID: 11049237

OBJECTIVES: To prospectively study the intervention rate, duration of labour, malpositions, fetal outcome, maternal satisfaction, voiding complications and adverse events in healthy primigravidae in spontaneous labour at term following epidural analgesia.
METHODS: A prospective randomized study involving 55 patients in the epidural group and 68 in the control pethidine--inhalational entonox group.
RESULTS: There were significantly more obstetric interventions (instrumental deliveries) in the epidural group (p < 0.01). The total duration of labour and the duration of the second stage was prolonged in the epidural group (p < 0.01). There were more malpositions at the second stage of labour in the epidural group (p < 0.02). There were no differences in fetal outcome (Apgar scores and Special Care Nursery admissions). Patients in the epidural group were consistently happier with their method of pain relief (p < 0.01). Two patients required blood patches while another 2 patients had persistent backache post epidural analgesia.
CONCLUSION: Epidural analgesia in primigravidae in spontaneous labour at term led to an increased instrumental delivery rate, prolonged duration of labour, greater rate of malpositions in the second stage, increased oxytocin requirements but with no difference in fetal outcomes but with happier mothers as compared to the control group.

Matched MeSH terms: Analgesia, Epidural*; Analgesia, Obstetrical*
Fulltext Acceptability of epidural analgesia for pain relief during labour among Kelantanese women

Sharma S, Mohamad NA, Monga D, Achana S

Med J Malaysia, 1996 Dec;51(4):453-6.
PMID: 10968033

Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.

Matched MeSH terms: Analgesia, Epidural*; Analgesia, Obstetrical*
Fulltext Randomised controlled trial on the effectiveness of audible timed reminders for simulated serial pain score documentation in an emergency department

Ng, V.H., Ahmad Khaldun, I., Siti Sarah, M.Z., Ida Zarina, Z.

Medicine & Health, 2018;13(2):114-121.
MyJurnal

Pain is one of commonest presentations at Emergency Department (ED). Previous studies showed inadequate pain control in ED. However, few have addressed specific, practical methods of improving the timeliness and frequency of pain control in emergency setting. This study was a randomized controlled trial in a simulated environment of an actual functioning ED using a timer device to remind care personnel to assess pain and provide analgesia at set intervals versus a “standard therapy” group without visual/audio aids. The mean documentation performance scores between timer and control groups were 94.45% + 5.85 vs 72.22% + 17.57 (p

Matched MeSH terms: Analgesia
Fulltext Evaluation of two different doses of pre-emptive intravenous magnesium sulphate as post- operative adjunct analgesia after gynaecological surgery

Tan, H.Y., Cheah, S.K., Joanna, O.S.M., Azrin, M.A.

Medicine & Health, 2020;15(2):164-174.
MyJurnal

Kajian ini dilaksanakan untuk membandingkan keberkesanan analgesia pre-emptif intravena magnesium sulfat menggunakan dos yang berbeza terhadap kesan pengawalan kesakitan berikutan pembedahan ginekologi. Seramai 56 orang pesakit dengan Indeks Jisim Badan (BMI)

Matched MeSH terms: Analgesia
Fulltext Combined spinal-epidural analgesia in labour: its effects on delivery outcome

Singh SK, Yahya N, Misiran K, Masdar A, Nor NM, Yee LC

Braz J Anesthesiol, 2016 May-Jun;66(3):259-64.
PMID: 27108822 DOI: 10.1016/j.bjane.2014.09.006

BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome.

METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared.

RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups.

CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Matched MeSH terms: Analgesia, Epidural/methods*; Analgesia, Obstetrical/methods*
Fulltext The current practice of sedation and analgesia in intensive care units in Malaysian public hospitals

Ahmad N, Tan CC, Balan S

Med J Malaysia, 2007 Jun;62(2):122-6.
PMID: 18705443 MyJurnal

We sought to review the current practice of sedation and analgesia in intensive care units (ICUs) in Malaysian public hospitals. A questionnaire survey was designed and sent by mail to 40 public hospitals with ICU facility in Malaysia. The anaesthesiologists in charge of ICU were asked to complete the questionnaire. Thirty seven questionnaires were returned (92.5% response rate). Only 35% respondents routinely assess the degree of sedation. The Ramsay scale was used prevalently. A written protocol for sedation was available in only 14 centers (38%). Although 36 centers (95%) routinely adjust the degree of sedation according to patient's clinical progress, only 10 centers (14%) interrupt sedation on a daily basis. Most respondents agreed that the selection of agents for sedation depends on familiarity (97%), pharmacology (97%), the expected duration for sedation (92%), patient's clinical diagnosis (89%) and cost (73%). Midazolam (89%) and morphine (86%) were the most commonly used agents for sedation and analgesia, respectively. Only 14% respondents still frequently use neuromuscular blocking agents, mostly in head injury patients. Our survey showed similarity in the choice of sedative and analgesic agents in ICUs in Malaysian public hospitals comparable to international practice. Nevertheless, the standard of practice could still be improved by implementing the practice of sedation score assessment and daily interruption of sedative infusion as well as having a written protocol for sedation and analgesia.

Matched MeSH terms: Analgesia/methods*
Fulltext Epidural buprenorphine and bupivacaine in major gynaecological operations

Loh SP

Med J Malaysia, 1993 Jun;48(2):207-10.
PMID: 8350797

Eight patients underwent major gynaecological operations. Their post-operative analgesia was provided by epidural buprenorphine 0.15 mg and bupivacaine 0.5%. The efficacy and side-effects of this combination were assessed. All patients had satisfactory analgesia ranging in duration from 10 hours to greater than 36 hours after a single dose injection. No significant side-effect was noted.

Matched MeSH terms: Analgesia, Epidural/methods*
A Malaysian retrospective study of acupuncture-assisted anesthesia in breast lump excision

Ang JY, Bhojwani K, Chan HK, Chan AC

Acupunct Med, 2021 02;39(1):64-68.
PMID: 32539426 DOI: 10.1177/0964528420920307

INTRODUCTION: The objective of this retrospective study was to evaluate the effectiveness and safety of acupuncture-assisted anesthesia (AAA) in breast lump excision.
METHODS: The medical records of all patients who underwent breast lump excision under AAA in combination with electrical stimulation at traditional acupuncture points in 2016 were examined. All of them (n = 17) received electrostimulation (2-4 Hz) using single needles inserted at bilateral LI4 and PC6. They also underwent insertion of four acupuncture needles at the lump site, which were electrically stimulated at 30 Hz frequency.
RESULTS: All surgical procedures were successful with minimal use of analgesics and local anesthetic. The median pain score reported was 1/10 (interquartile range (IQR) = 2/10) at the first hour, and slightly increased to 2/10 (IQR = 2/10) between 24 and 48 h of the surgery. No major postoperative adverse events were documented, except for drowsiness in one case.
CONCLUSION: AAA was found to be generally safe and effective for anaesthesia and analgesia in breast lump excision. However, a large-scale randomized controlled study is required to verify the findings.

Matched MeSH terms: Acupuncture Analgesia*
Fulltext Comparison between patient-controlled epidural analgesia and continuous epidural infusion for pain relief after gynaecological surgery

Suhaila, N., Nurlia, Y., Azmil Farid, Z., Melvin, K., Muhammad, M., Nadia, M.N.

Journal of Surgical Academia, 2013;3(2):14-19.
MyJurnal

This prospective, randomised study compared the effectiveness of patient controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI) in providing pain relief post gynaecological surgery. Sixty six ASA I or II patients planned for gynaecological surgery via Pfannensteil incision under combined spinal epidural anaesthesia were recruited. They were randomised into two groups: Group A patients received PCEA while Group B patients received CEI. In the recovery area, both groups received an epidural combination of levobupivacaine 0.1% and fentanyl 2 μg/ml. Group A patients were allowed demand bolus doses of 5 ml with a 20 minute lockout interval, while Group B patients had their epidural infusion initiated at 6 ml/hour with increments as required to a maximum of 12 ml/hour. Pain score and degree of motor blockade was assessed hourly in the first four hours and subsequently at four hourly intervals. Side effects were recorded at four-hourly interval. The total amount of analgesia, number of anaesthetic interventions and patient satisfaction was assessed 24 hours, postoperatively. There was no significant difference in pain score, total amount of analgesia, number of anaesthetic interventions and patient satisfaction. The degree of motor blockade and side effects were comparable between the groups. In conclusion, PCEA was comparable to CEI for pain relief after gynaecological surgery.

Matched MeSH terms: Analgesia, Epidural; Analgesia, Patient-Controlled
Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

Saiboon IM, Singmamae N, Jaafar MJ, Muniandy BK, Sengmamae K, Hamzah FA, et al.

Saudi Med J, 2014 Jul;35(7):718-23.
PMID: 25028229

To evaluate the effectiveness of a new patient flow system, `The Red Box` on the quality of patient care in respect of the time taken for the care to be delivered to the patient.

Matched MeSH terms: Analgesia*
Fulltext Hot water immersion as a treatment for stonefish sting: A case report

Darlene FO, Phee-Kheng C

Malays Fam Physician, 2013;8(1):28-32.
PMID: 25606265 MyJurnal

The North Borneo state of Sabah is known worldwide for its beautiful islands and dive sites. Local hospitals deal with a number of marine-related injuries, including marine fauna envenomation by Scorpaenidae and Synanceiidae families of fish. We report a case of a tourist who presented with excruciating pain on her right foot after stepping on a stonefish. Despite being given parenteral analgesia and regional anaesthesia, the pain persisted. Her pain improved after she soaked her foot in hot water for about 30 minutes. No further treatment was required. We reviewed the literature comparing this inexpensive mode of treatment with other conventional treatments. We also explored the possibility of using hot water immersion for treatment of envenomation by other types of marine animals.

Matched MeSH terms: Analgesia
Fulltext [Combined spinal-epidural analgesia in labour: its effects on delivery outcome]

Singh SK, Yahya N, Misiran K, Masdar A, Nor NM, Yee LC

Rev Bras Anestesiol, 2016 May-Jun;66(3):259-64.
PMID: 26993410 DOI: 10.1016/j.bjan.2014.09.009

Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome.

Matched MeSH terms: Analgesia, Epidural
Fulltext Early detection, appropriate management - ensure a legacy of good health

Amir, S.K.

JUMMEC, 2009;12(2):44-46.
MyJurnal

The current volume of JUMMEC contains a wide spectrum of health topics highlighting the importance of controlling metabolic factors in diabetes, selection of heart failure patients for innovative treatment, early postoperative analgesia, testing of a translated screener for urinary tract problems, problems when commissioning a new operating theatre and breastfeeding issues.(Copied from article).

Matched MeSH terms: Analgesia
Fulltext Comparison of patient controlled epidural analgesia (PCEA) with basal infusion and programmed intermittent epidural bolus (PIEB) with PCEA in labour analgesia – A year retrospective study

Zawiah Kassim, Norliza Mohd Nor, Ariffah Mokhtar, Suhaina Mohamad, Sarina Osman, Isqandar Adnan

Journal of Clinical and Health Sciences, 2021;6(1):25-31.
MyJurnal

Introduction: Over three decades, patient-controlled epidural analgesia with a basal infusion
regimen (PCEA+BI) has successfully improved labour analgesia quality due to its advantage
in allowing self-titration by the parturients. Recently, a newer programmed intermittent epidural
bolus with PCEA regimen (PIEB+PCEA) was suggested to improve the epidural spread of
local anaesthetic hence resulted in better analgesia quality and higher maternal satisfaction.
Methods: We conducted a one-year retrospective analysis of data from obstetric analgesia
service record sheet and hospital information system comparing maternal satisfaction towards
their labour analgesia quality, mode of delivery and neonatal Apgar scores between these two
methods of epidural delivery techniques. A total of 343 parturients were recruited in this study
(PCEA+BI n=171, PIEB+PCEA n=172). Results: There were no significant difference in
maternal satisfaction between the two groups (P=0.398) with a higher percentage of excellent
satisfaction were found in the PIEB+PCEA group (PIEB+PCEA 146/172 (84.9%) vs PCEA+BI
138/171 (80.7%)). No significant difference in the mode of delivery (P=0.296). However, the
PIEB+PCEA group shown a higher spontaneous vaginal delivery rate (PIEB+PCEA 87/172
(50.6%) vs PCEA+BI 70/171 (40.9%) and lower Caesarean delivery rate (PIEB+PCEA 71/172
(41.3%) vs PCEA+BI 87/171 (50.9%)). Despite statistically significant differences found in
Apgar scores at 1 minute (P=0.036), there was no significant difference in the scores at 5
minutes (P=0.107). Mean Apgar scores (SD) at 1 minute and 5 minutes for PIEB+ PCEA were
7.77(0.85) and 8.91(0.55) respectively and for PCEA + basal infusion, the scores for 1 minute
and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA is
a newer epidural delivery technique for labour analgesia which produces a comparable
outcome to PCEA with basal infusion.

Matched MeSH terms: Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesia, Obstetrical
The effectiveness of patient-controlled epidural analgesia with ropivacaine 0.165% with fentanyl 2.0 miroc g/ml or levobupivacaine 0.125% with fentanyl 2.0 micro g/ml as a method of postoperative analgesia after major orthopaedic surgery

Misiran KB, Yahaya LS

Middle East J Anaesthesiol, 2013 Feb;22(1):59-64.
PMID: 23833852

This prospective randomized single-blinded study was conducted to determine whether there were differences in consumption, demand dosing and postoperative analgesia quality between PCEA using ropivacaine and levobupivacaine. Seventy patients with ASA classification I and II aged 18 to 80 years old scheduled for elective total knee replacement or total hip replacement were studied. All patients received CSE and then were randomly allocated to receive either ropivacaine 0.165% (Group A) or levobupivacaine 0.125% (Group B) both added with fentanyl 2.0 mcro g/ml via epidural route. PCEA regime was offered for 48 hours with additional standard orthopaedic practice of oral analgesia (etoricoxib 120 mg OD and paracetamol 1.0 gm QID) on the second postoperative day. Basal infusion of PCEA was at 3.0 ml/hour and discontinued after 24 hours following started of PCEA. The consumption of local anaesthetics used within the first 24 hours (basal + demand) and 48 hours (total basal + total demand) were recorded. The VAS pain score, sedation score, side effects and vital signs (blood pressure, heart rate and respiratory rate) were also recorded every four hours for 48 hours. This study showed that the total volume of drug used was significantly higher in Group A (163.31+/- 29.01 ml) than Group B (142.69 +/- 30.93ml) (p<0. 01). The mean dose of Group A for the first 48 hours after surgery was 251.43 +/- 70.02mg and was significantly greater than the mean dose of Group B (178.91 +/-42.33 mg) (p<0.01). The numbers of PCEA boluses delivered (D) and PCEA attempts (A) were higher in the Group A (22.37 +/-7.32 and 27.66 +/- 9.12) in contrast to Group B (17.63 +/- 7.71 and 24.40 +/- 11.51) but the differences were not statistically significant. The ratio D/A showed significantly higher in Group A (0.83 +/- 0.13) than Group B (0.74 +/- 0.15) (p<0. 02). The VAS pain score was similar for both groups. One patient in Group B had vomiting and there was no sedation, hypotension, pruritus or motor block recorded in both groups. In conclusion this study showed that both PCEA using ropivacaine 0.165% with fentanyl 2.0 micro g/ml and levobupivacaine 0.125% with fentanyl 2.0 micro g/ml provided effective postoperative analgesia within the first 48 hours of major lower limb orthopaedic surgery despite clinically significant dose difference. There was no hypotension, pruritus, sedation or motor block recorded in both groups.

Matched MeSH terms: Analgesia, Epidural*; Analgesia, Patient-Controlled*
Fulltext Analgesia and Anaesthesia Management of Labour and Caesarean Delivery for a Parturient with Paramyotonia Congenita

Najid NM, Razak TA, Günaydın DB

Turk J Anaesthesiol Reanim, 2019 Aug;47(4):345-347.
PMID: 31380517 DOI: 10.5152/TJAR.2019.69094

Anaesthetic management in paramyotonia congenita (PC) or 'paradoxical myotonia' poses perioperative challenges to the anaesthesiologists both in obstetric and non-obstetric surgical patients. There are only a few case reports on the anaesthesia management particularly in the obstetric population. Therefore, we aimed to present the management of analgesia of labour and emergency caesarean delivery for a 26-year-old parturient with PC.

Matched MeSH terms: Analgesia

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