Pub Date : 2025-12-02DOI: 10.1016/j.ijoa.2025.104826
Ayman Mohamady Eldemrdash, Mohamed A Alazhary, Soudy S Hammad, Tarek S Hemaida, Ahmed Mohamed Reda Ragheb, Gamal Hendawy Shams, Taha Tairy Dardeer, Zaher Zaki Zaher
Background: Pruritus is a common adverse effect of neuraxial morphine after cesarean delivery. We tested whether intravenous lidocaine infusion reduces the incidence and severity of neuraxial morphine-induced pruritus.
Methods: In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150 μg and were randomized to either intravenous lidocaine (bolus 1.5 mg/kg followed by infusion 1.5 mg/kg/h for 6 h) or saline placebo. The primary outcome was the incidence of pruritus within 24 h. Secondary outcomes included pruritus severity over time, rescue nalbuphine use, and adverse events. Analyses used modified intention-to-treat.
Results: Data on 136 patients were analyzed (n = 69 lidocaine vs. n = 67 controls). Pruritus occurred in 36.2% receiving lidocaine vs 73.1% in the control group (absolute risk reduction 36.9%, 95% CI 21.4, 52.4), resulting in a number needed to treat of 3 (95% CI 2, 5). Rescue nalbuphine was given in 23.2% of patients in the lidocaine group vs. 56.7% in the control group (absolute risk reduction 33.5%, 95% CI 18.0, 49.0), with a number needed to treat of 3 (95% CI 2, 6). Pruritus severity was lower in the lidocaine group during the first 12 h postoperatively; differences were not significant at 16 and 24 h. No symptoms of lidocaine toxicity or increased adverse events were observed.
Conclusions: Intravenous lidocaine infusion reduced the incidence and early severity of neuraxial morphine-induced pruritus after cesarean delivery without increased adverse events. Further work should define lower effective doses and shorter infusion durations compatible with enhanced recovery pathways.
背景：瘙痒是剖宫产后常见的神经轴吗啡不良反应。我们测试了静脉输注利多卡因是否能降低吗啡引起的神经轴性瘙痒的发生率和严重程度。方法：在单中心双盲随机试验中，160名在鞘内吗啡150 μg脊髓麻醉下择期剖宫产的妇女，随机分为静脉注射利多卡因组（静脉注射1.5 mg/kg，随后再输注1.5 mg/kg/h，持续6 h）和生理盐水安慰剂组。主要结局是24小时内瘙痒的发生率。次要结局包括随时间推移的瘙痒严重程度、抢救使用纳布啡和不良事件。分析使用改良的意向治疗。结果：136例患者的数据被分析（n = 69利多卡因vs n = 67对照组）。利多卡因组出现瘙痒的比例为36.2%，对照组为73.1%（绝对风险降低36.9%,95% CI 21.4, 52.4），导致需要治疗的人数为3人（95% CI 2,5）。利多卡因组23.2%的患者给予纳布啡抢救，对照组56.7%（绝对风险降低33.5%,95% CI 18.0, 49.0），需要治疗的人数为3人（95% CI 2,6）。利多卡因组术后12 h瘙痒严重程度较低；16和24小时时差异不显著。未观察到利多卡因毒性症状或不良事件增加。结论：静脉输注利多卡因可降低剖宫产后神经轴性吗啡性瘙痒的发生率和早期严重程度，且未增加不良事件。进一步的工作应该确定更低的有效剂量和更短的输注时间，以增强恢复途径。
{"title":"Intravenous lidocaine infusion reduces intrathecal opioid-induced pruritus after cesarean delivery: a randomized controlled trial and proof-of-concept.","authors":"Ayman Mohamady Eldemrdash, Mohamed A Alazhary, Soudy S Hammad, Tarek S Hemaida, Ahmed Mohamed Reda Ragheb, Gamal Hendawy Shams, Taha Tairy Dardeer, Zaher Zaki Zaher","doi":"10.1016/j.ijoa.2025.104826","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104826","url":null,"abstract":"<p><strong>Background: </strong>Pruritus is a common adverse effect of neuraxial morphine after cesarean delivery. We tested whether intravenous lidocaine infusion reduces the incidence and severity of neuraxial morphine-induced pruritus.</p><p><strong>Methods: </strong>In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150 μg and were randomized to either intravenous lidocaine (bolus 1.5 mg/kg followed by infusion 1.5 mg/kg/h for 6 h) or saline placebo. The primary outcome was the incidence of pruritus within 24 h. Secondary outcomes included pruritus severity over time, rescue nalbuphine use, and adverse events. Analyses used modified intention-to-treat.</p><p><strong>Results: </strong>Data on 136 patients were analyzed (n = 69 lidocaine vs. n = 67 controls). Pruritus occurred in 36.2% receiving lidocaine vs 73.1% in the control group (absolute risk reduction 36.9%, 95% CI 21.4, 52.4), resulting in a number needed to treat of 3 (95% CI 2, 5). Rescue nalbuphine was given in 23.2% of patients in the lidocaine group vs. 56.7% in the control group (absolute risk reduction 33.5%, 95% CI 18.0, 49.0), with a number needed to treat of 3 (95% CI 2, 6). Pruritus severity was lower in the lidocaine group during the first 12 h postoperatively; differences were not significant at 16 and 24 h. No symptoms of lidocaine toxicity or increased adverse events were observed.</p><p><strong>Conclusions: </strong>Intravenous lidocaine infusion reduced the incidence and early severity of neuraxial morphine-induced pruritus after cesarean delivery without increased adverse events. Further work should define lower effective doses and shorter infusion durations compatible with enhanced recovery pathways.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"104826"},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ijoa.2025.104827
L.B. Squires, D.J. Conti, E.E. Martinez, N. Guo, B. Carvalho, C.M. Ortner
Background
Focused cardiac ultrasound is an effective tool for assessing obstetric patients, but access to phased array transducers is limited in many low-resource settings. This study aimed to determine if curvilinear transducers could produce clinically useful ultrasound images non-inferior to phased array transducers.
Methods
Laboring patients were recruited for focused cardiac ultrasound performed by six anesthesiologists with limited echocardiography experience. Curvilinear and phased array transducers were used to obtain standard views. The first transducer used was randomly assigned. Blinded experts graded the images on a scale of 1 to 5, with grades ≥ 3 sufficient for clinical decisions. The primary outcome was the percentage of patients with sufficient images (grade ≥ 3) in at least two views using curvilinear versus phased array transducers. Secondary outcomes included the clinical utility of individual views and a non-inferiority comparison of transducers.
Results
Seventy parturients were scanned. Clinically useful examinations were achieved in 91.4% (95% CI 82.3%, 96.8%) of patients with curvilinear transducers compared to 95.7% (95% CI 88.0%, 99.1%) with phased array transducers. Using a noninferiority margin of 15%, curvilinear transducers were noninferior for clinical decisions (−4.3% 90% CI: −11.9%, −3.3%) largely due to parasternal views. Subcostal and apical views were individually inconclusive and IVC views were inferior. Measures of cardiac dimensions and systolic function were deemed measurable with less frequency on curvilinear images but concordant when measured.
Conclusions
Anesthesiologists can effectively use curvilinear transducers for focused cardiac ultrasound in obstetric patients, although phased array transducers may be superior for measuring cardiac dimensions and function.
聚焦心脏超声是评估产科患者的有效工具，但在许多资源匮乏的环境中，相控阵换能器的使用受到限制。本研究旨在确定曲线换能器是否可以产生临床有用的超声图像，而不逊色于相控阵换能器。方法选取临产患者，由6名超声心动图经验有限的麻醉师进行心脏聚焦超声检查。曲线和相控阵换能器被用来获得标准视图。使用的第一个换能器是随机分配的。盲法专家将图像按1 - 5级进行评分，评分≥3级足以用于临床决策。主要结局是使用曲线与相控阵换能器在至少两个视图中获得足够图像（分级≥3）的患者百分比。次要结果包括个体视图的临床效用和换能器的非劣效性比较。结果共扫描70例产妇。曲线换能器的91.4% （95% CI 82.3%, 96.8%）患者获得了临床有用的检查，而相控阵换能器的95.7% （95% CI 88.0%, 99.1%）患者获得了临床有用的检查。使用15%的非劣效性裕度，曲线传感器在临床决策中是非劣效性的（- 4.3% 90% CI: - 11.9%, - 3.3%），主要是由于胸骨旁视图。肋下和根尖位单独不确定，下颌骨位次之。测量心脏尺寸和收缩功能被认为是可测量的，在曲线图像上频率较低，但测量时一致。结论虽然相控阵换能器在测量心脏尺寸和功能方面更胜一筹，但曲线换能器可以有效地用于产科患者的聚焦心脏超声。
{"title":"Curvilinear versus phased array transducer: using the obstetric ultrasound for focused cardiac ultrasound in laboring patients - a randomized controlled assessment","authors":"L.B. Squires, D.J. Conti, E.E. Martinez, N. Guo, B. Carvalho, C.M. Ortner","doi":"10.1016/j.ijoa.2025.104827","DOIUrl":"10.1016/j.ijoa.2025.104827","url":null,"abstract":"<div><h3>Background</h3><div>Focused cardiac ultrasound is an effective tool for assessing obstetric patients, but access to phased array transducers is limited in many low-resource settings. This study aimed to determine if curvilinear transducers could produce clinically useful ultrasound images non-inferior to phased array transducers.</div></div><div><h3>Methods</h3><div>Laboring patients were recruited for focused cardiac ultrasound performed by six anesthesiologists with limited echocardiography experience. Curvilinear and phased array transducers were used to obtain standard views. The first transducer used was randomly assigned. Blinded experts graded the images on a scale of 1 to 5, with grades ≥ 3 sufficient for clinical decisions. The primary outcome was the percentage of patients with sufficient images (grade ≥ 3) in at least two views using curvilinear versus phased array transducers. Secondary outcomes included the clinical utility of individual views and a non-inferiority comparison of transducers.</div></div><div><h3>Results</h3><div>Seventy parturients were scanned. Clinically useful examinations were achieved in 91.4% (95% CI 82.3%, 96.8%) of patients with curvilinear transducers compared to 95.7% (95% CI 88.0%, 99.1%) with phased array transducers. Using a noninferiority margin of 15%, curvilinear transducers were noninferior for clinical decisions (−4.3% 90% CI: −11.9%, −3.3%) largely due to parasternal views. Subcostal and apical views were individually inconclusive and IVC views were inferior. Measures of cardiac dimensions and systolic function were deemed measurable with less frequency on curvilinear images but concordant when measured.</div></div><div><h3>Conclusions</h3><div>Anesthesiologists can effectively use curvilinear transducers for focused cardiac ultrasound in obstetric patients, although phased array transducers may be superior for measuring cardiac dimensions and function.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104827"},"PeriodicalIF":2.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijoa.2025.104824
S.E. Harkins , C.D. Thomas II , I.I. Hulchafo , M Topaz , R Landau , V Barcelona
Background
Stigmatizing language reflects provider bias. Researchers found that documentation of stigmatizing language in obstetric clinical notes differed by patient race and ethnicity. The purpose of this study was to examine associations between postoperative pain and stigmatizing language documented by anesthesiologists.
Methods
We studied the electronic health records of obstetric patients at two hospitals between 2017 and 2019 (n = 4383). Pain was defined as a verbal numerical pain score (VNPS) 1 following cesarean delivery or other operative procedure during the delivery hospitalization. Stigmatizing language was identified in the free-text narratives of postoperative anesthesia notes using a well-performing natural language processing algorithm. Multivariable logistic regression was employed to examine associations between pain and stigmatizing language.
Results
Stigmatizing language was found in 9.9% of postoperative notes. Patients with documented pain were significantly more likely to have any stigmatizing language documented by anesthesiologists compared with patients with no pain (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.26–2.13). Patients with pain were also significantly more likely to have language labeling them as ‘difficult’ (aOR, 1.81; 95% CI, 1.34–2.45). There were no significant differences between patients with and without postoperative pain in language related to marginalized language/identities, unilateral/authoritarian decisions, or questioning patient credibility categories.
Conclusions
In this cross-sectional study, postpartum patients with pain had increased odds of stigmatizing language. Findings suggest anesthesiologists may perceive patients who report pain as being ‘difficult.’ Quality improvement studies should track inequities in pain management as patient-centered, bias-free care is crucial for improving perinatal equity.
{"title":"Patient-reported postoperative pain and stigmatizing language in anesthesia notes: a cross-sectional study (2017–2019)","authors":"S.E. Harkins , C.D. Thomas II , I.I. Hulchafo , M Topaz , R Landau , V Barcelona","doi":"10.1016/j.ijoa.2025.104824","DOIUrl":"10.1016/j.ijoa.2025.104824","url":null,"abstract":"<div><h3>Background</h3><div>Stigmatizing language reflects provider bias. Researchers found that documentation of stigmatizing language in obstetric clinical notes differed by patient race and ethnicity. The purpose of this study was to examine associations between postoperative pain and stigmatizing language documented by anesthesiologists.</div></div><div><h3>Methods</h3><div>We studied the electronic health records of obstetric patients at two hospitals between 2017 and 2019 (n = 4383). Pain was defined as a verbal numerical pain score (VNPS) <span><math><mo>≥</mo></math></span> 1 following cesarean delivery or other operative procedure during the delivery hospitalization. Stigmatizing language was identified in the free-text narratives of postoperative anesthesia notes using a well-performing natural language processing algorithm. Multivariable logistic regression was employed to examine associations between pain and stigmatizing language.</div></div><div><h3>Results</h3><div>Stigmatizing language was found in 9.9% of postoperative notes. Patients with documented pain were significantly more likely to have any stigmatizing language documented by anesthesiologists compared with patients with no pain (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.26–2.13). Patients with pain were also significantly more likely to have language labeling them as ‘difficult’ (aOR, 1.81; 95% CI, 1.34–2.45). There were no significant differences between patients with and without postoperative pain in language related to marginalized language/identities, unilateral/authoritarian decisions, or questioning patient credibility categories.</div></div><div><h3>Conclusions</h3><div>In this cross-sectional study, postpartum patients with pain had increased odds of stigmatizing language. Findings suggest anesthesiologists may perceive patients who report pain as being ‘difficult.’ Quality improvement studies should track inequities in pain management as patient-centered, bias-free care is crucial for improving perinatal equity.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104824"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijoa.2025.104822
Noor Joudi, Nidhee S Reddy, Elizabeth B Sherwin, Metabel Markwei, Janet Hurtado, Samantha L Simpson, Jordan J Burgess, Stephanie A Leonard, Miriam Schultz, Brendan Carvalho, Pervez Sultan, Katherine Bianco, Danielle M Panelli
Background: Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.
Methods: We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023-2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24-48 h post-delivery. The primary outcome was opioid use (0-48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24-48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.
Results: Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2nd [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3rd (aOR 5.74; CI 1.54-21.4), and 4th (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, P = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, P = 0.029).
Conclusions: Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.
{"title":"Adverse childhood experiences and post-cesarean pain and in-hospital opioid use: a prospective cohort study.","authors":"Noor Joudi, Nidhee S Reddy, Elizabeth B Sherwin, Metabel Markwei, Janet Hurtado, Samantha L Simpson, Jordan J Burgess, Stephanie A Leonard, Miriam Schultz, Brendan Carvalho, Pervez Sultan, Katherine Bianco, Danielle M Panelli","doi":"10.1016/j.ijoa.2025.104822","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104822","url":null,"abstract":"<p><strong>Background: </strong>Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.</p><p><strong>Methods: </strong>We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023-2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24-48 h post-delivery. The primary outcome was opioid use (0-48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24-48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.</p><p><strong>Results: </strong>Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2<sup>nd</sup> [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3<sup>rd</sup> (aOR 5.74; CI 1.54-21.4), and 4<sup>th</sup> (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, P = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, P = 0.029).</p><p><strong>Conclusions: </strong>Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"104822"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijoa.2025.104823
K. Li, Y. Li, P.E. Hess, A.A. Berger
Von Willebrand disease (VWD) is a family of disorders involving quantitative or qualitative deficiencies of von Willebrand factor. Type 2N von Willebrand disease is a rare variant in which defective von Willebrand factor fails to stabilize factor VIII. Factor VIII deficiency may pose increased risks of postpartum hemorrhage and spinal-epidural hematoma after neuraxial analgesia, yet clinical guidance on its peripartum management remains extremely limited.
This case reports on the successful administration of neuraxial analgesia in a 23-year-old nulliparous patient with type 2N VWD who presented with active vaginal bleeding and impending preterm delivery. Targeted preprocedural correction of factor VIII and von Willebrand factor levels, with adjunct thromboelastography, enabled uneventful neuraxial analgesia administration and uncomplicated preterm vaginal delivery. No complications from neuraxial were noted. However, despite satisfactory factor VIII and von Willebrand factor levels at discharge, the patient experienced delayed postpartum bleeding requiring readmission.
This case demonstrates the feasibility of neuraxial labor analgesia in women with type 2N VWD after thorough risk assessment and mitigation, interdisciplinary collaboration, and individualized care. The occurrence of delayed bleeding additionally underscores the importance of postpartum monitoring as factor levels decline. This report contributes to the limited but growing body of evidence on obstetric anesthesia neuraxial procedures in the setting of rare bleeding disorders.
{"title":"Neuraxial labor analgesia in type 2N von Willebrand disease: a case report","authors":"K. Li, Y. Li, P.E. Hess, A.A. Berger","doi":"10.1016/j.ijoa.2025.104823","DOIUrl":"10.1016/j.ijoa.2025.104823","url":null,"abstract":"<div><div>Von Willebrand disease (VWD) is a family of disorders involving quantitative or qualitative deficiencies of von Willebrand factor. Type 2N von Willebrand disease is a rare variant in which defective von Willebrand factor fails to stabilize factor VIII. Factor VIII deficiency may pose increased risks of postpartum hemorrhage and spinal-epidural hematoma after neuraxial analgesia, yet clinical guidance on its peripartum management remains extremely limited.</div><div>This case reports on the successful administration of neuraxial analgesia in a 23-year-old nulliparous patient with type 2N VWD who presented with active vaginal bleeding and impending preterm delivery. Targeted preprocedural correction of factor VIII and von Willebrand factor levels, with adjunct thromboelastography, enabled uneventful neuraxial analgesia administration and uncomplicated preterm vaginal delivery. No complications from neuraxial were noted. However, despite satisfactory factor VIII and von Willebrand factor levels at discharge, the patient experienced delayed postpartum bleeding requiring readmission.</div><div>This case demonstrates the feasibility of neuraxial labor analgesia in women with type 2N VWD after thorough risk assessment and mitigation, interdisciplinary collaboration, and individualized care. The occurrence of delayed bleeding additionally underscores the importance of postpartum monitoring as factor levels decline. This report contributes to the limited but growing body of evidence on obstetric anesthesia neuraxial procedures in the setting of rare bleeding disorders.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104823"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijoa.2025.104821
T L Abirami, P Rudingwa, A K Jha, A Kuberan, N S Kubera, S Ramachandran, B Ravichandrane
{"title":"Corrigendum to \"Effect of prophylactic intravenous calcium gluconate on uterine atony during intrapartum cesarean delivery with spinal anesthesia: a placebo controlled, randomized clinical trial\". [Int. J. Obst. Anesth. 63 (2025) 104704].","authors":"T L Abirami, P Rudingwa, A K Jha, A Kuberan, N S Kubera, S Ramachandran, B Ravichandrane","doi":"10.1016/j.ijoa.2025.104821","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104821","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":" ","pages":"104821"},"PeriodicalIF":2.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.ijoa.2025.104820
S.L. Armstrong , A.A. Berger , S. Zec, M. Douek, K. Li, M.C. Borrelli, Y. Li, P.E. Hess
Background
Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events
Methods
We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022–2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.
Results
There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.
Conclusions
Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.
背景：右美托咪定是一种高度选择性的α - 2肾上腺素能受体激动剂，具有抗焦虑、镇静和镇痛作用。这种药物在产科麻醉中的使用越来越多，出版物描述了静脉注射（IV）用于颤抖，硬膜外和鞘内用于麻醉和镇痛。关于临床使用中不良事件发生频率的数据有限。我们回顾了我们在围产期使用右美托咪定的情况，以确定具体的适应症和产妇不良事件。方法：我们回顾性回顾了三年来（2022-2024）在分娩和分娩过程中使用右美托咪定的情况。收集给药途径、适应症和剂量，并记录所有可识别的与右美托咪定给药相关的不良事件。结果：有1177条记录可供回顾，1100条记录被分析。右美托咪定最常用于增强剖宫产麻醉，治疗分娩时突发性疼痛和颤抖。产妇心率异常47例（6.1%,95% CI 4.5-8.0），心动过缓16例（2.1%,95% CI 1.2-3.4），低血压57例（7.2%,95% CI 5.5-9.3），镇静9例（1.2%,95% CI 0.6-2.3）。与静脉给药相比，静脉给药后母体不良事件较少。结论：我们的临床经验表明，母体不良事件可能与静脉给药或静脉给药有关，静脉给药后母体不良事件更为常见。由于不良事件可能与剂量有关，我们建议从最低适当剂量开始，并逐渐达到预期效果。
{"title":"Maternal hemodynamic effects associated with intravenous and neuraxial dexmedetomidine during labor and cesarean delivery: a single center retrospective study (2021–2024)","authors":"S.L. Armstrong , A.A. Berger , S. Zec, M. Douek, K. Li, M.C. Borrelli, Y. Li, P.E. Hess","doi":"10.1016/j.ijoa.2025.104820","DOIUrl":"10.1016/j.ijoa.2025.104820","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine is a highly selective alpha<sub>2</sub>-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events</div></div><div><h3>Methods</h3><div>We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022–2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.</div></div><div><h3>Results</h3><div>There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.</div></div><div><h3>Conclusions</h3><div>Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104820"},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.ijoa.2025.104817
S. Ciechanowicz , P. Callihan , G. Michel , D.M. Panelli , B. Carvalho , P. Sultan
Background
Chronic postsurgical pain after caesarean delivery affects 10–20% of women at 3–6 months postpartum, yet its broader impact on recovery is underexplored. This study examined lived experiences of chronic postsurgical pain and identified key domains of impact.
Methods
Twenty-four women with self-reported pain at 3–6 months after intrapartum or planned caesarean delivery were recruited from two prospective studies. Semi-structured interviews, conducted in English or Spanish via secure video call, were transcribed and analysed using inductive reflexive thematic analysis.
Results
Patients described a multidimensional, interconnected symptom burden. Pain persisted or worsened unpredictably, interfering with mobility, infant care, and daily life. Poor sleep and fatigue compounded distress. Cognitive and affective disruptions, including anxiety and fear, were common. Many patients avoided opioid analgesics due to concerns about alertness or breastfeeding. Patients sometimes reported feeling dismissed or unsupported by healthcare professionals. Ten themes were identified: pain and sensory disruption; functional limitations and fatigue; interference with infant care and identity; psychological distress and cognitive load; sleep disruption; control and coping; intimacy and embodied recovery; healthcare gaps; peer and online normalisation; and reflections on future health.
Conclusions
Chronic pain after caesarean rarely occurs in isolation. Interacting symptoms across sleep, pain, emotional wellbeing, cognitive function, and energy domains shape women’s lived experiences. These findings provide qualitative support for a multidomain, possibly syndromic pattern of postpartum pain and recovery.
{"title":"Patient experiences of chronic postsurgical pain after caesarean delivery: findings from a prospective qualitative study","authors":"S. Ciechanowicz , P. Callihan , G. Michel , D.M. Panelli , B. Carvalho , P. Sultan","doi":"10.1016/j.ijoa.2025.104817","DOIUrl":"10.1016/j.ijoa.2025.104817","url":null,"abstract":"<div><h3>Background</h3><div>Chronic postsurgical pain after caesarean delivery affects 10–20% of women at 3–6 months postpartum, yet its broader impact on recovery is underexplored. This study examined lived experiences of chronic postsurgical pain and identified key domains of impact.</div></div><div><h3>Methods</h3><div>Twenty-four women with self-reported pain at 3–6 months after intrapartum or planned caesarean delivery were recruited from two prospective studies. Semi-structured interviews, conducted in English or Spanish via secure video call, were transcribed and analysed using inductive reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Patients described a multidimensional, interconnected symptom burden. Pain persisted or worsened unpredictably, interfering with mobility, infant care, and daily life. Poor sleep and fatigue compounded distress. Cognitive and affective disruptions, including anxiety and fear, were common. Many patients avoided opioid analgesics due to concerns about alertness or breastfeeding. Patients sometimes reported feeling dismissed or unsupported by healthcare professionals. Ten themes were identified: pain and sensory disruption; functional limitations and fatigue; interference with infant care and identity; psychological distress and cognitive load; sleep disruption; control and coping; intimacy and embodied recovery; healthcare gaps; peer and online normalisation; and reflections on future health.</div></div><div><h3>Conclusions</h3><div>Chronic pain after caesarean rarely occurs in isolation. Interacting symptoms across sleep, pain, emotional wellbeing, cognitive function, and energy domains shape women’s lived experiences. These findings provide qualitative support for a multidomain, possibly syndromic pattern of postpartum pain and recovery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104817"},"PeriodicalIF":2.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.ijoa.2025.104819
E. Takalo , M. Karpala , X. An , B. Cobb , S. Zhao , R. Bari , M. Hylton , S. Grant , J. Schoenherr
Background
Intrathecal opioids are the standard adjuvant for spinal anesthesia in cesarean delivery, but investigating alternatives is warranted. A community hospital began adding intrathecal dexmedetomidine 10 µg to spinal anesthetics for cesarean deliveries due to a local shortage in opioids. This retrospective study evaluates its impact on postoperative pain, opioid use, and hemodynamic outcomes.
Methods
After IRB approval, cesarean delivery cases conducted between 2019 and 2020 were screened. Exclusion criteria included epidural labor analgesia, general anesthesia, intrathecal catheters, or intrathecal dexmedetomidine dose other than 10 µg. Primary outcome was postoperative pain score; secondary outcomes included opioid use (in milligram morphine equivalents), incidence of intraoperative hypotension, vasopressor use, postoperative mean arterial pressure, Apgar scores, and length of stay.
Results
Of 572 cesarean deliveries, 414 met inclusion criteria; 163 received 10 µg of intrathecal dexmedetomidine, 251 did not. Demographics were similar. Patients who received intrathecal dexmedetomidine 10 µg had significantly lower postoperative pain scores (effect size −0.41, 95% CI −0.18 to −0.64; P < 0.001). Opioid use was significantly reduced 0–6 h after anesthesia (15.0 mg vs. 22.5 mg; P < 0.001) and 6–24 h after anesthesia end (26.1 mg vs. 29.4 mg; P = 0.0465). However, there was a higher incidence of intraoperative hypotension (44.2% vs. 28.3%; P < 0.001).
Conclusion
Intrathecal dexmedetomidine 10 µg was associated with reduced postoperative pain and opioid use, supporting its role as an intrathecal adjuvant. However, its association with increased hypotension highlights the need for cautious use and further investigation.
背景：鞘内阿片类药物是剖宫产脊髓麻醉的标准辅助剂，但研究替代方案是有必要的。由于当地阿片类药物短缺，一家社区医院开始在剖宫产脊髓麻醉药中加入鞘内右美托咪定10µg。本回顾性研究评估其对术后疼痛、阿片类药物使用和血流动力学结果的影响。方法：对经IRB批准的2019 ~ 2020年剖宫产病例进行筛查。排除标准包括硬膜外分娩镇痛、全身麻醉、鞘内插管或鞘内右美托咪定剂量超过10µg。主要结局为术后疼痛评分；次要结局包括阿片类药物使用（毫克吗啡当量）、术中低血压发生率、血管加压药物使用、术后平均动脉压、Apgar评分和住院时间。结果：572例剖宫产中，414例符合纳入标准；163例鞘内注射10µg右美托咪定，251例未注射。人口统计数据相似。鞘内注射右美托咪定10µg的患者术后疼痛评分显著降低（效应值-0.41,95% CI -0.18至-0.64；P）结论：鞘内注射右美托咪定10µg与术后疼痛和阿片类药物使用减少相关，支持其作为鞘内佐剂的作用。然而，它与低血压升高的相关性强调了谨慎使用和进一步研究的必要性。
{"title":"Intrathecal dexmedetomidine for cesarean delivery and postoperative outcomes: a single-center retrospective cohort study (2019–2020)","authors":"E. Takalo , M. Karpala , X. An , B. Cobb , S. Zhao , R. Bari , M. Hylton , S. Grant , J. Schoenherr","doi":"10.1016/j.ijoa.2025.104819","DOIUrl":"10.1016/j.ijoa.2025.104819","url":null,"abstract":"<div><h3>Background</h3><div>Intrathecal opioids are the standard adjuvant for spinal anesthesia in cesarean delivery, but investigating alternatives is warranted. A community hospital began adding intrathecal dexmedetomidine 10 µg to spinal anesthetics for cesarean deliveries due to a local shortage in opioids. This retrospective study evaluates its impact on postoperative pain, opioid use, and hemodynamic outcomes.</div></div><div><h3>Methods</h3><div>After IRB approval, cesarean delivery cases conducted between 2019 and 2020 were screened. Exclusion criteria included epidural labor analgesia, general anesthesia, intrathecal catheters, or intrathecal dexmedetomidine dose other than 10 µg. Primary outcome was postoperative pain score; secondary outcomes included opioid use (in milligram morphine equivalents), incidence of intraoperative hypotension, vasopressor use, postoperative mean arterial pressure, Apgar scores, and length of stay.</div></div><div><h3>Results</h3><div>Of 572 cesarean deliveries, 414 met inclusion criteria; 163 received 10 µg of intrathecal dexmedetomidine, 251 did not. Demographics were similar. Patients who received intrathecal dexmedetomidine 10 µg had significantly lower postoperative pain scores (effect size −0.41, 95% CI −0.18 to −0.64; <em>P</em> < 0.001). Opioid use was significantly reduced 0–6 h after anesthesia (15.0 mg vs. 22.5 mg; <em>P</em> < 0.001) and 6–24 h after anesthesia end (26.1 mg vs. 29.4 mg; <em>P</em> = 0.0465). However, there was a higher incidence of intraoperative hypotension (44.2% vs. 28.3%; <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Intrathecal dexmedetomidine 10 µg was associated with reduced postoperative pain and opioid use, supporting its role as an intrathecal adjuvant. However, its association with increased hypotension highlights the need for cautious use and further investigation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104819"},"PeriodicalIF":2.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.ijoa.2025.104816
M.A. Helmy , K.A. Helmy , M.R. Salem , M.A. El-Monem Morsy , M. Fikry , L.M. Milad
Background
While the systemic effects of magnesium sulfate administration are well described, its effects on gastric motility and aspiration risk remain underexplored. We evaluated the effect of magnesium sulfate administration on the gastric antrum cross-sectional area (CSA) in the setting of preeclampsia with severe features.
Methods
This prospective observational study included 31 patients with preeclampsia and severe features receiving an intravenous bolus of magnesium sulfate 5 g over 20 min, followed by an infusion (1 g/h). Gastric ultrasound was performed at baseline (pre-bolus) and 10- and 20-min post-bolus. Serum magnesium levels were measured at baseline and 20 min post-bolus. The primary outcome was the change in gastric CSA from baseline to 20 min post-bolus. The secondary outcomes included the proportion of patients with unsafe gastric volume (CSA > 608 mm2) and correlation between the increasing serum magnesium levels and change in CSA.
Results
There was an increase in gastric antrum CSA from baseline to 10- and 20-min post-bolus, with median CSA values rising from 403 mm2 to 440 mm2 and 507 mm2, respectively (P < 0.001). Serum magnesium levels increased from 1.96 ± 0.26 mg/dL to 5.24 ± 0.86 mg/dL (mean difference: 3.27 ± 0.80 mg/dL). At baseline and 10- and 20-min post-bolus, 2, 5, and 7 of 31 participants, respectively, met criteria for unsafe gastric volume. A strong positive correlation was observed between change in serum magnesium levels and change in CSA (r = +0.896, P < 0.001)
Conclusions
In patients with preeclampsia with severe features, magnesium sulfate 5 g is associated with a significant increase in gastric antrum CSA. The strong positive correlation between serum magnesium levels and CSA supports a potential dose-dependent effect on gastric smooth muscle relaxation. However, further research is warranted to determine whether these sonographic changes correspond to clinically significant increases in gastric volume or translate into a measurable risk of pulmonary aspiration.
{"title":"Effect of magnesium sulfate in patients with preeclampsia with severe features on gastric antrum cross-sectional area: a prospective observational study","authors":"M.A. Helmy , K.A. Helmy , M.R. Salem , M.A. El-Monem Morsy , M. Fikry , L.M. Milad","doi":"10.1016/j.ijoa.2025.104816","DOIUrl":"10.1016/j.ijoa.2025.104816","url":null,"abstract":"<div><h3>Background</h3><div>While the systemic effects of magnesium sulfate administration are well described, its effects on gastric motility and aspiration risk remain underexplored. We evaluated the effect of magnesium sulfate administration on the gastric antrum cross-sectional area (CSA) in the setting of preeclampsia with severe features.</div></div><div><h3>Methods</h3><div>This prospective observational study included 31 patients with preeclampsia and severe features receiving an intravenous bolus of magnesium sulfate 5 g over 20 min, followed by an infusion (1 g/h). Gastric ultrasound was performed at baseline (pre-bolus) and 10- and 20-min post-bolus. Serum magnesium levels were measured at baseline and 20 min post-bolus. The primary outcome was the change in gastric CSA from baseline to 20 min post-bolus. The secondary outcomes included the proportion of patients with unsafe gastric volume (CSA > 608 mm<sup>2</sup>) and correlation between the increasing serum magnesium levels and change in CSA.</div></div><div><h3>Results</h3><div>There was an increase in gastric antrum CSA from baseline to 10- and 20-min post-bolus, with median CSA values rising from 403 mm<sup>2</sup> to 440 mm<sup>2</sup> and 507 mm<sup>2</sup>, respectively (<em>P</em> < 0.001). Serum magnesium levels increased from 1.96 ± 0.26 mg/dL to 5.24 ± 0.86 mg/dL (mean difference: 3.27 ± 0.80 mg/dL). At baseline and 10- and 20-min post-bolus, 2, 5, and 7 of 31 participants, respectively, met criteria for unsafe gastric volume. A strong positive correlation was observed between change in serum magnesium levels and change in CSA (r = +0.896, <em>P</em> < 0.001)</div></div><div><h3>Conclusions</h3><div>In patients with preeclampsia with severe features, magnesium sulfate 5 g is associated with a significant increase in gastric antrum CSA. The strong positive correlation between serum magnesium levels and CSA supports a potential dose-dependent effect on gastric smooth muscle relaxation. However, further research is warranted to determine whether these sonographic changes correspond to clinically significant increases in gastric volume or translate into a measurable risk of pulmonary aspiration.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104816"},"PeriodicalIF":2.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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