OBJECTIVES: To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth. PATIENTS AND METHODS: Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out. RESULTS: Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable. CONCLUSIONS: Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.

Analgesia, Epidural↗

PubMedDate not supplied

[Prevalence of anti-hepatitis A in patients with chronic liver disease].

The recent availability of an effective vaccine for preventing hepatitis A has led to the performance of a prevalence study of antibodies versus the hepatitis A virus (HAV) in our patients with chronic liver disease by hepatitis B and C, as a step prior to vaccination. The sera of 425 patients with a mean age of 40 years was studied, with the global antibodies versus HAV being determined (Abbott). The prevalence was to 75.2% varying from 20% at 19 years to 93% in those over the age of 40. The prevalence was not related to sex, previous parenteral history, or drug addiction or infection by hepatitis B or C. Due to previous cost-benefit studies and the high prevalence found, the determination of anti-HAV in patients with chronic viral liver diseases prior to vaccination against HAV is recommended.

Adolescent↗