疼痛诊疗学课件：分娩镇痛.pptVIP

Epidural analgesia Continuous epidural infusion -0.04%bupivacaine plus fentanyl:almost all patients will require at lease one resuse bolus,some need more than seven -0,083%bupivacaine plus sufentanil:53%requre at least one rescue,18%need two or more -complication:intravascular or intrathecal infusion Epidural analgesia Patient controlled epidural analgesia minimize drug dosage.flexibility and benefits of self administration reduced demand on professional time controversy still exists regarding the use of a continuous basal infusion in addition to patient controlled boluses which would provide for a more even block and larger doses Epidural analgesia Complications -hypotension -convulsion -cardiac arrest deliver the fetus,external cardiac massage defibrillation epinephrine bretylium -total spinal airway,trendelenburg,fluid,pressure support Epidural analgesia Complications nerve injury rare epidural hematoma infection, meningitis headache Regional anesthesia CSE rapid onset reliability patient can walk if only intrathecal opiate given (in Ob patient) epinephrine test dose for epidural catheter placement is more reliable after intrathecal opiate is given because the patient is pain free Complication of cesarean section Uterine laceration,uterine atony and increased risk of placenta accreta Bladder,ureteral injury and G1 tract injury Infection of wound and uterine post-op Rupture of uterrrrrrus Anesthsia related Death rate;5.6-6.1/100,00 Possible strategies to reduce the rate of cesarean section Equalize the reimbursement for vaginal and cesarean deliveries Publish physician-specfic cesarean rates Publish hospital-specific cesarean rates Address physician malpractice concern though legislation Application of CSE in the operating room Abdominal surgeries such as colectomy,bilateral recurrent inquinal heria repair and abdominal aortic aneurysm repair Orthopedic sur