International journal of obstetric anesthesia最新文献

{"title":"Discrimination, racism, and bias in childbirth pain management in the United States: a scoping review and directions for research and clinical care","authors":"S.E. Harkins ,&nbsp;A.K. Hazi ,&nbsp;J. Guglielminotti ,&nbsp;R. Landau ,&nbsp;V. Barcelona","doi":"10.1016/j.ijoa.2025.104379","DOIUrl":"10.1016/j.ijoa.2025.104379","url":null,"abstract":"<div><div>Racial and ethnic disparities in obstetric analgesia care persist in the United States. There is a paucity of validated tools to measure how discrimination, racism, and bias affect obstetric anesthesia care. As a result, little is known about how racism and other forms of discrimination impact pain management during childbirth. In this scoping review, we evaluated 11 studies that quantitatively measured or qualitatively described experiences of discrimination, racism, or bias in childbirth pain management among birthing people in the United States. Studies focused on birthing people with marginalized identities due to race and ethnicity, disability status, history of opioid use disorder, and health insurance status. We provide nine recommendations for research and 14 recommendations for clinical practice to mitigate the impact of interpersonal, institutional, and structural discrimination in obstetric anesthesia care. Future research should prioritize quantitative analyses between structural discrimination and childbirth pain management, and employ an intersectional approach to improve care for birthing people with multiple marginalized identities. Clinical practice recommendations include developing rapport and trust with birthing people before labor analgesia is needed, diversifying the labor and delivery workforce, establishing patient-family advisory councils, and encouraging professional societies to advocate for equitable perinatal health policies.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104379"},"PeriodicalIF":2.6,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928786","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}

{"title":"Is it time to standardise the definition of difficult intubation in obstetric anaesthesia?","authors":"Yitzhak Brzezinski Sinai,&nbsp;Carolyn Fiona Weiniger","doi":"10.1016/j.ijoa.2025.104377","DOIUrl":"10.1016/j.ijoa.2025.104377","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104377"},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908163","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}

{"title":"Preoperative gastric ultrasound guiding anesthetic management of a patient with cyclic vomiting syndrome: a case report","authors":"Saranya Lertkovit ,&nbsp;Lauren Anderson ,&nbsp;William Camann","doi":"10.1016/j.ijoa.2025.104365","DOIUrl":"10.1016/j.ijoa.2025.104365","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104365"},"PeriodicalIF":2.6,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844936","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}

{"title":"Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements","authors":"Antonio Gonzalez-Fiol ,&nbsp;Kristen L. Fardelmann ,&nbsp;Ruth Landau","doi":"10.1016/j.ijoa.2025.104360","DOIUrl":"10.1016/j.ijoa.2025.104360","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104360"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792393","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}

{"title":"Spinal morphine for cesarean delivery: a little goes a long way.","authors":"Philip E Hess, Richard Smiley","doi":"10.1016/j.ijoa.2025.104363","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104363","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":" ","pages":"104363"},"PeriodicalIF":2.6,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811372","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}

{"title":"Racial health disparities in severe maternal morbidity before and after implementation of an enhanced recovery after cesarean delivery protocol: a retrospective observational study at two NYC hospitals (2016–2020)","authors":"A.T. Gilman ,&nbsp;J. Kim ,&nbsp;S.Y. Jiang ,&nbsp;S.E. Abramovitz ,&nbsp;R.S. White","doi":"10.1016/j.ijoa.2025.104362","DOIUrl":"10.1016/j.ijoa.2025.104362","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after cesarean delivery (ERAC) is an evidence-based pathway that aims to improve the quality of care for all patients. Standardization of care has been seen as a tool to promote equality and equity. Our goal was to evaluate racial differences in severe maternal morbidity (SMM) among patients before and after implementation of an ERAC program.</div></div><div><h3>Methods</h3><div>A retrospective study was performed among cesarean delivery patients pre- and post-ERAC implementation at two large academic hospitals in New York City from October 2016 to September 2020. Logistic regression models were created to compare peripartum SMM complications pre-ERAC, post-ERAC, and overall, by race.</div></div><div><h3>Results</h3><div>The sample consisted of 7,812 cesarean delivery patients, of which 4,640 were pre-ERAC (59.4%) and 3172 were post-ERAC (40.6%). Within the overall population, Black (aOR 1.57, 95% CI 1.07 to 2.28; <em>P</em>=0.018) and Asian (aOR 1.61, 95% CI 1.20 to 2.14; <em>P</em>=0.001) patients had higher odds of SMM compared to white patients. Pre-ERAC, Black (aOR 1.92, 95% CI 1.16 to 3.14; <em>P</em>=0.010) and Asian patients (aOR 1.86, 95% CI 1.26 to 2.74; <em>P</em>=0.002) had higher odds of SMM relative to white patients. Post-ERAC, this relationship was no longer statistically significant [Black (aOR 1.13, 95% CI 0.61 to 2.01; <em>P</em>=0.69) and Asian (aOR 1.39, 95% CI 0.88 to 2.17; <em>P</em>=0.15)].</div></div><div><h3>Conclusion</h3><div>Implementation of the ERAC protocol improved SMM outcomes by race. Standardization of practices in ERAC protocols can help address disparities by reducing variations in obstetrical care.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104362"},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767654","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}

{"title":"Low dose intrathecal morphine for post-cesarean analgesia with scheduled multimodal pain regimen: a prospective, randomized, open blinded end-point study","authors":"K.H. Hatter ,&nbsp;N.W. Shugart ,&nbsp;N. Paladugu ,&nbsp;H. Nitchie ,&nbsp;B. Wolf ,&nbsp;L. Hebbar","doi":"10.1016/j.ijoa.2025.104361","DOIUrl":"10.1016/j.ijoa.2025.104361","url":null,"abstract":"<div><h3>Background</h3><div>The intrathecal morphine dose in combination with multimodal analgesia providing optimal pain management post-cesarean delivery while minimizing side effects has not been determined. We performed a prospective, randomized, open blinded end-point study comparing intrathecal morphine 50 μg vs. 100 μg combined with scheduled intravenous ketorolac and oral acetaminophen for post-cesarean delivery analgesia.</div></div><div><h3>Methods</h3><div>Participants received intrathecal hyperbaric bupivacaine 12 mg, fentanyl 15 µg and a randomized dose of intrathecal morphine 50 μg vs. 100 μg followed by intravenous ketorolac 30 mg every six hours and oral acetaminophen 1000 mg every eight hours for the first 24 hours. Oral oxycodone and intravenous morphine were administered based on pain scores. The primary outcome was time to first analgesic request (opioid rescue dose) in the first 24 hours, analyzed using intent to treat and the hypothesis of non-inferiority using a log-rank testing approach and assuming a non-inferiority margin of a hazard ratio of 1.65.</div></div><div><h3>Results</h3><div>There were 201 participants randomized to intrathecal morphine 50 μg vs. 100 μg. The median time to first rescue dose was 23.5 hours postoperatively for the 50 μg cohort (95% CI 15.2, 28.3) and 22.9 hours postoperatively with the 100 μg cohort (95% CI 13.8, 28.2). The probability of requesting an opioid rescue dose was similar between the two treatment groups during the first 24 hours. Postoperative pruritus, nausea, vomiting, total opioids used, pain at rest and with ambulation, and time to first ambulation were not different between the two cohorts.</div></div><div><h3>Conclusion</h3><div>With ketorolac and acetaminophen, intrathecal morphine 50 μg was not inferior to 100 μg evaluating time to first opioid rescue dose and opioid use over time. There were no differences in secondary outcomes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104361"},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial bleed from an epidural puncture site: a case report","authors":"R. Cowden,&nbsp;R. Hignett","doi":"10.1016/j.ijoa.2025.104357","DOIUrl":"10.1016/j.ijoa.2025.104357","url":null,"abstract":"<div><div>This case highlights a rare complication of superficial arterial bleeding from an epidural puncture site.</div><div>A 27-year-old primigravida was admitted for induction of labour at 38 weeks' gestation due to obstetric cholestasis. An epidural for labour analgesia was inserted at spinal level L4-L5 with a 16G Tuohy needle. Blood-stained fluid was noted on aspiration, prompting its removal. Subsequently, there appeared to be arterial bleeding from the epidural site, which persisted despite prolonged pressure with epinephrine and tranexamic acid soaked swabs. The bleeding was ultimately controlled using a purse-string suture and subcutaneous epinephrine 20 μg on each side of the bleeding site, with a<!--> <!-->total estimated blood loss of 500 mL. There were no neurological concerns and no cardiovascular changes or evidence of formation of a superficial haematoma following the interventions.</div><div>Epidural related arterial bleeding is exceptionally rare and the primary concern is the risk of an epidural haematoma, especially if the source of the bleeding is unknown. There are only four case reports in the literature detailing superficial arterial bleeding following an epidural with differing management strategies including a purse-string suture or varying doses of subcutaneous epinephrine (30 μg−300 μg). Both techniques carry potential risks.<!--> <!-->In this case, a combination of a purse-string suture and low-dose subcutaneous epinephrine effectively controlled the bleeding, with no complications. We recommend using the lowest effective dose of subcutaneous epinephrine with vigilant maternal and fetal monitoring. Any lower limb neurological changes warrants urgent imaging and a neurosurgical evaluation to exclude an epidural haematoma.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104357"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is prophylactic tranexamic acid effective in preventing postpartum hemorrhage? almost certainly no","authors":"Anne-Sophie Bouthors ,&nbsp;Maxence Hureau ,&nbsp;Alexander Butwick","doi":"10.1016/j.ijoa.2025.104356","DOIUrl":"10.1016/j.ijoa.2025.104356","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104356"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776779","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}

{"title":"In response to “Patient perspectives in obstetric anaesthesia reports: invaluable learning for clinicians”","authors":"R. Eshel,&nbsp;A. Berman,&nbsp;C.F. Weiniger","doi":"10.1016/j.ijoa.2025.104358","DOIUrl":"10.1016/j.ijoa.2025.104358","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104358"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747030","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}