International journal of obstetric anesthesia最新文献

英文中文

Response to correspondence from McCarthy et al. regarding maternal sepsis screening and the role of the neutrophil-to-lymphocyte ratio 对McCarthy等人关于母体败血症筛查和中性粒细胞与淋巴细胞比例作用的回复。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-10-30 DOI: 10.1016/j.ijoa.2025.104804

T. Culling , D. Camilleri , C. Bertorelli , A. Strang , S. Oram , F. Faggian , S. Sharma , A. Ridgway , S. Zaher , M. Labeta , S.A. Jones , L.C. Davies , J. Watkins , K. Siddall , V. Keeping , K. Simpson , M. Bray , P. Ghazal , S.F. Bell , R.E. Collis

引用次数: 0

Postdural puncture headache in obstetrics: revisiting long-term outcomes while reframing risk, consent, and postpartum follow-up 产科硬脊膜穿刺后头痛：重新审视长期结果，同时重新定义风险、同意和产后随访。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-11-01 DOI: 10.1016/j.ijoa.2025.104813

C. Delgado , L. Leffert

引用次数: 0

Nurse workforce diversity and use of neuraxial labor analgesia in the United States 护士队伍的多样性和使用神经轴分娩镇痛在美国

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-11-01 DOI: 10.1016/j.ijoa.2025.104814

J. Guglielminotti , R. Landau , M. Russell , G. Li

Background

Diversification of the healthcare workforce is promoted to address racial and ethnic disparities in obstetric anesthesia care; however, the supporting evidence remains insufficient. We assessed the association of the nurse workforce diversity with neuraxial labor analgesia (NLA) use and disparities in NLA use.

Methods

We analyzed 2019–2022 US birth certificate data for vaginal and intrapartum cesarean deliveries. The exposure was the registered nurse (RN) diversity index in the hospital county, calculated as the proportion of RNs identifying with minoritized racial and ethnic groups divided by the proportion of the county’s total population identifying with those groups. The index was categorized into quartiles with the first quartile indicating the lowest diversity. The outcome was NLA use. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of NLA associated with the diversity index were estimated using mixed-effects logistic regression models.

Results

We analyzed 10,979,988 birth certificates. Overall, 80.0% recorded NLA use. Relative to women who gave birth in hospitals in the first quartile of the RN diversity index (low diversity), the odds of receiving NLA increased 10% for women in the fourth quartile (high diversity) of the index (aOR: 1.10; 95% CI: 1.06, 1.14). Compared with White women, increased odds of receiving NLA associated with higher RN workforce diversity were more pronounced among Hispanic, Black, Asian, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander women.

Conclusions

RN workforce diversity was positively associated with NLA use and reduced disparities in NLA use.

促进医疗保健工作人员的多样化，以解决产科麻醉护理中的种族和民族差异；然而，支持证据仍然不足。我们评估了护士队伍多样性与神经轴分娩镇痛（NLA）使用的关系以及NLA使用的差异。方法分析2019-2022年美国阴道和产宫中剖宫产的出生证明数据。暴露量为医院县注册护士（RN）多样性指数，计算方法为认同少数种族和族裔群体的注册护士比例除以该县总人口认同这些群体的比例。该指数分为四分位数，第一个四分位数表示最低的多样性。结果是NLA的使用。使用混合效应logistic回归模型估计NLA与多样性指数相关的调整优势比（aORs）和95%置信区间（CIs）。结果我们分析了10979988份出生证明。总体而言，80.0%的人使用了NLA。相对于在护士多样性指数的第一个四分位数（低多样性）的医院分娩的妇女，在该指数的第四个四分位数（高多样性）的妇女接受NLA的几率增加了10% （aOR: 1.10; 95% CI: 1.06, 1.14）。与白人女性相比，在西班牙裔、黑人、亚裔、美洲印第安人或阿拉斯加原住民、夏威夷原住民或其他太平洋岛民女性中，接受NLA的几率增加与更高的RN劳动力多样性有关。结论srn员工多样性与NLA使用呈正相关，并降低了NLA使用的差异。

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引用次数: 0

Effect of magnesium sulfate in patients with preeclampsia with severe features on gastric antrum cross-sectional area: a prospective observational study 硫酸镁对重度子痫前期患者胃窦横截面积影响的前瞻性观察研究

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 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.

背景：虽然硫酸镁的全身性作用已被很好地描述，但其对胃运动和误吸风险的影响仍未被充分探讨。我们评估硫酸镁对重度子痫前期患者胃窦横截面积（CSA）的影响。方法本前瞻性观察研究纳入31例有严重子痫前期症状的患者，在20分钟内静脉滴注硫酸镁5 g，然后以1 g/h的速度输注。在基线（服药前）和服药后10分钟和20分钟进行胃超声检查。在基线和丸后20分钟测量血清镁水平。主要结果是胃CSA从基线到丸后20分钟的变化。次要结局包括胃容量不安全（CSA > 608 mm2）患者的比例以及血清镁水平升高与CSA变化的相关性。结果注射后10分钟和20分钟胃窦CSA从基线增加，中位CSA值分别从403 mm2上升到440 mm2和507 mm2 （P < 0.001）。血清镁水平从1.96±0.26 mg/dL上升至5.24±0.86 mg/dL（平均差值3.27±0.80 mg/dL）。在基线和丸后10分钟和20分钟，31名参与者中分别有2名、5名和7名符合不安全胃容量标准。血清镁水平变化与CSA变化呈极显著正相关（r = +0.896, P < 0.001）结论在重度子痫前期患者中，硫酸镁5 g与胃窦CSA显著升高相关。血清镁水平与CSA之间的强正相关支持胃平滑肌松弛的潜在剂量依赖性作用。然而，需要进一步的研究来确定这些超声变化是否与临床显著的胃容量增加相对应，或者转化为可测量的肺误吸风险。

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引用次数: 0

Patient experiences of chronic postsurgical pain after caesarean delivery: findings from a prospective qualitative study 剖宫产后慢性术后疼痛的患者经历：一项前瞻性定性研究的结果。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-11-15 DOI: 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.

背景：10-20%的妇女在产后3-6个月发生剖腹产术后慢性疼痛，但其对恢复的广泛影响尚未得到充分探讨。本研究调查了慢性术后疼痛的生活经历，并确定了影响的关键领域。方法：从两项前瞻性研究中招募了24名在产时或计划剖宫产后3-6个月自我报告疼痛的妇女。通过安全视频通话以英语或西班牙语进行的半结构化访谈，使用归纳反思性主题分析进行转录和分析。结果：患者描述了一个多维的，相互关联的症状负担。疼痛持续或恶化，影响活动、婴儿护理和日常生活。睡眠不足和疲劳加剧了痛苦。认知和情感障碍，包括焦虑和恐惧，很常见。由于担心警觉或母乳喂养，许多患者避免使用阿片类镇痛药。患者有时报告感觉被医疗保健专业人员忽视或不支持。确定了十个主题：疼痛和感觉中断；功能限制和疲劳；对婴儿护理和身份的干扰；心理困扰与认知负荷；睡眠中断;控制与应对；亲密关系与身体康复；医疗差距;对等和在线正常化；以及对未来健康的思考。结论：剖宫产后慢性疼痛很少单独发生。睡眠、疼痛、情绪健康、认知功能和能量领域的相互作用症状塑造了女性的生活经历。这些发现为产后疼痛和恢复的多领域、可能的综合征模式提供了定性支持。

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引用次数: 0

In response to “Ten plus ten equals twenty: a prospective crossover study evaluating syringe size and speed of epidural injection” 回应“十加十等于二十：评估硬膜外注射注射器大小和速度的前瞻性交叉研究”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-24 DOI: 10.1016/j.ijoa.2025.104843

Daniel F. Berenson, Sharon C. Reale

引用次数: 0

Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023) 鞘内2-氯普鲁卡因3% 60 mg和芬太尼15 μg用于宫颈环扎术的结果：一项回顾性质量保证研究（2021 - 2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-10-22 DOI: 10.1016/j.ijoa.2025.104808

Ebubechukwu Obiora , Richard M. Smiley , Prahlad G. Menon , Allison J. Lee

Background

In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose.

Methods

We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022).

Results

A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (P = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, P < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort.

Conclusion

Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.

在我们机构之前的一项研究中，比较了鞘内氯普鲁卡因和布比卡因用于颈椎环扎术的脊髓麻醉，鞘内使用2-氯普鲁卡因3% 50 mg和芬太尼15 μg与9%的患者术中不适相关，促使实践改变剂量增加到60 mg。我们报告两年来高剂量治疗的结果。方法回顾性分析2021年7月~ 2023年7月在2-氯普鲁卡因3% 60 mg和芬太尼15 μg脊髓麻醉下行阴道宫颈环切术的患者。结果包括手术持续时间、麻醉补充、从脊髓注射到满足出院标准的时间，以及术后第1天电话记录的术后问题（n=122，从2022年7月开始）。结果共纳入患者208例。中位手术时间为17[11-25]分钟。60 mg组的补给率较低（2% vs 9%(2/22)），但该研究缺乏统计学能力来证实显著差异（P = 0.104）；没有人需要全身麻醉。从脊髓注射到出院的中位时间为186[163-218]分钟，而先前50 mg队列的中位时间为158[137-188]分钟(中位差异为- 15.0分钟（- 20.5至- 9.5,P < 0.001）。无患者报告短暂性神经症状、行走困难或排尿。1人报告背部疼痛，3人报告腹部不适。结论鞘内2-氯普鲁卡因3% 60 mg联合芬太尼麻醉失败较少（但无统计学意义），出院时间略长于50 mg。

{"title":"Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023)","authors":"Ebubechukwu Obiora , Richard M. Smiley , Prahlad G. Menon , Allison J. Lee","doi":"10.1016/j.ijoa.2025.104808","DOIUrl":"10.1016/j.ijoa.2025.104808","url":null,"abstract":"<div><h3>Background</h3><div>In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022).</div></div><div><h3>Results</h3><div>A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (<em>P</em> = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, <em>P</em> < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort.</div></div><div><h3>Conclusion</h3><div>Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104808"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358974","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}

引用次数: 0

The World Federation Societies of Anaesthesiologists’ (WFSA) declaration on patients’ right to labour analgesia: raising awareness and elevating the role of anaesthesiologists in global maternal health 世界麻醉师协会联合会（麻醉师协会）关于患者分娩镇痛权的宣言：提高认识并提升麻醉师在全球孕产妇保健中的作用。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-09-29 DOI: 10.1016/j.ijoa.2025.104784

E. Guasch, R.B. George

引用次数: 0

Intravenous lidocaine infusion reduces intrathecal opioid-induced pruritus after cesarean delivery: a randomized controlled trial and proof-of-concept 静脉输注利多卡因减少剖宫产后鞘内阿片类药物引起的瘙痒：一项随机对照试验和概念证明。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-02 DOI: 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

μ

g 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":"10.1016/j.ijoa.2025.104826","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>In this double-blind randomized trial at a single center, 160 women undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine 150 <span><math><mi>μ</mi></math></span>g 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104826"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","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}

引用次数: 0

Anaesthesia practices for caesarean delivery in three clinical scenarios: the French CLATAC survey (2022–2023) 三种临床情况下剖宫产的麻醉实践：法国CLATAC调查（2022-2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-09-29 DOI: 10.1016/j.ijoa.2025.104785

C. Garcia Cabrol , J.C. Sleth , J. Pissarra , S. Bringuier , F. Fuchs , C. Dadure

Background

Intraoperative pain during caesarean delivery (CD) remains a concern, particularly with epidural anaesthesia, with variable incidence depending on the circumstances. While spinal anaesthesia is the standard for scheduled CD, the best approach for unscheduled CD, especially with inadequate conversion of labour epidural analgesia to surgical epidural anaesthesia, remains unclear. We aimed to describe preferred anaesthetic practices among French anaesthesiologists in different clinical scenarios, with a particular focus on intrapartum CD with failed conversion of labour epidural analgesia.

Methods

A nation-wide, anonymous, online survey was distributed to anaesthesiologists. Participants were asked to indicate their preferred practices in clinical scenarios, including cases without labour epidural analgesia, with adequate labour epidural analgesia, and with inadequate conversion to surgical epidural anaesthesia, for three emergency levels.

Results

Between November 2022 and January 2023, 651 anaesthesiologists responded. Most respondents indicated preferring spinal anaesthesia for scheduled (97 %) and unscheduled non-urgent CD without LEA (95 %). In emergency situations, general anaesthesia (GA) was preferred (84 %). With adequate labour epidural analgesia, 99 % favoured epidural conversion. With inadequate labour epidural analgesia, 43 % indicated preferring spinal anaesthesia in non-urgent situations, while 70 % would opt for GA in emergency cases. Only 63 % of respondents were aware of risk factors for epidural conversion failure.

Conclusions

Anaesthetic practices were heterogeneous, particularly with inadequate labour epidural analgesia. These findings highlight the need for broader dissemination of updated guidelines and for standardized, evidence-based, clinical decision algorithms to support safe and effective anaesthetic management in complex clinical scenarios.

背景：剖宫产（CD）术中疼痛仍然是一个值得关注的问题，特别是硬膜外麻醉，其发生率取决于具体情况。虽然脊髓麻醉是计划CD的标准，但计划外CD的最佳方法，特别是在分娩硬膜外镇痛不充分转化为手术硬膜外麻醉的情况下，仍不清楚。我们的目的是描述法国麻醉师在不同临床情况下的首选麻醉做法，特别关注分娩时硬膜外镇痛转换失败的分娩CD。方法：在全国范围内对麻醉医师进行匿名在线调查。参与者被要求指出他们在临床情况下的首选做法，包括在三种紧急情况下，无分娩硬膜外镇痛、分娩硬膜外充分镇痛和未充分转为手术硬膜外麻醉的情况。结果：在2022年11月至2023年1月期间，651名麻醉师做出了回应。大多数应答者表示首选脊髓麻醉的计划（97%）和非计划的非紧急CD没有LEA（95%）。在紧急情况下，首选全身麻醉（84%）。充分的分娩硬膜外镇痛，99%赞成硬膜外转换。由于分娩时硬膜外镇痛不足，43%的人表示在非紧急情况下更倾向于脊髓麻醉，而70%的人在紧急情况下会选择GA。只有63%的应答者知道硬膜外转换失败的危险因素。结论：麻醉实践是不同的，特别是分娩时硬膜外镇痛不足。这些发现强调需要更广泛地传播更新的指南和标准化的、循证的临床决策算法，以支持在复杂的临床情况下安全有效的麻醉管理。

{"title":"Anaesthesia practices for caesarean delivery in three clinical scenarios: the French CLATAC survey (2022–2023)","authors":"C. Garcia Cabrol , J.C. Sleth , J. Pissarra , S. Bringuier , F. Fuchs , C. Dadure","doi":"10.1016/j.ijoa.2025.104785","DOIUrl":"10.1016/j.ijoa.2025.104785","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative pain during caesarean delivery (CD) remains a concern, particularly with epidural anaesthesia, with variable incidence depending on the circumstances. While spinal anaesthesia is the standard for scheduled CD, the best approach for unscheduled CD, especially with inadequate conversion of labour epidural analgesia to surgical epidural anaesthesia, remains unclear. We aimed to describe preferred anaesthetic practices among French anaesthesiologists in different clinical scenarios, with a particular focus on intrapartum CD with failed conversion of labour epidural analgesia.</div></div><div><h3>Methods</h3><div>A nation-wide, anonymous, online survey was distributed to anaesthesiologists. Participants were asked to indicate their preferred practices in clinical scenarios, including cases without labour epidural analgesia, with adequate labour epidural analgesia, and with inadequate conversion to surgical epidural anaesthesia, for three emergency levels.</div></div><div><h3>Results</h3><div>Between November 2022 and January 2023, 651 anaesthesiologists responded. Most respondents indicated preferring spinal anaesthesia for scheduled (97 %) and unscheduled non-urgent CD without LEA (95 %). In emergency situations, general anaesthesia (GA) was preferred (84 %). With adequate labour epidural analgesia, 99 % favoured epidural conversion. With inadequate labour epidural analgesia, 43 % indicated preferring spinal anaesthesia in non-urgent situations, while 70 % would opt for GA in emergency cases. Only 63 % of respondents were aware of risk factors for epidural conversion failure.</div></div><div><h3>Conclusions</h3><div>Anaesthetic practices were heterogeneous, particularly with inadequate labour epidural analgesia. These findings highlight the need for broader dissemination of updated guidelines and for standardized, evidence-based, clinical decision algorithms to support safe and effective anaesthetic management in complex clinical scenarios.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104785"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212748","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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