Epidural catheter function during labor predicts anesthetic efficacy for subsequent cesarean delivery.

The Rate of Successful Reactivation of Labor Epidural Catheters for Postpartum Tubal Ligation Surgery

UNLABELLED: Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large. To evaluate the analgesic efficacy of local anesthetic infiltration, 20 parturients scheduled for elective minilaparotomy and bilateral tubal ligation with either spinal or epidural anesthesia participated in this prospective, randomized, controlled, double-blind trial. All patients received IV metoclopramide 10 mg and ketorolac 60 mg intraoperatively, as well as preincisional infiltration of the infraumbilical skin incision with 0.5% bupivacaine. Infiltration of bilateral uterine tubes and mesosalpinx was performed with either 0.5% bupivacaine (n = 10) or isotonic sodium chloride solution (saline) (n = 10). IV meperidine (25 mg every 3 min as needed) was given to treat pain in the postanesthesia care unit (PACU). The total amount of meperidine administered in the PACU was significantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seventh postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uterine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seventh postoperative day compared with infiltration with sodium chloride. IMPLICATIONS: During bilateral tubal ligation with either spinal or epidural anesthesia, preemptive analgesia using IV ketorolac, IV metoclopramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nausea, vomiting, or cramping and to maintain good analgesia for 7 days postoperatively.

Effective analgesia after bilateral tubal ligation.

UNLABELLED We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectiveness of intraperitoneal lidocaine, IM morphine, or both drugs together for pain relief in postpartum tubal ligation. Eighty postpartum patients scheduled to have tubal sterilization were randomly divided into four groups to receive IM isotonic sodium chloride solution (1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group P); IM morphine (10 mg in 1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group M); IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 0.5% lidocaine in 80 mL (Group L); and both IM morphine and intraperitoneal lidocaine instillation (Group ML). The minilaparotomy was performed after local infiltration with 15 mL of 1% lidocaine. A numerical rating score was used to rate pain on a 0-10 scale during the surgical procedures. The mean pain scores were 1.2 in Group L and 0.8 in Group ML. These pain scores were significantly lower than those in Groups P and M, which were 5.5 and 6.0, respectively (P < 0.001). IMPLICATIONS Pain relief was inadequate in patients undergoing postpartum tubal ligation under local anesthesia, even after the administration of IM morphine. Instilling lidocaine into the abdominal cavity, however, effectively decreased intraoperative pain in these patients.

Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation.

Labor epidural catheter reactivation or spinal anesthesia for delayed postpartum tubal ligation: a cost comparison.

Epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor.

Epidural Anesthesia for

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Epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor.

Epidural Anesthesia for