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To investigate the effect of epidural injection of 1.5% chloroprocaine on breakthrough pain during labor analgesia. Methods A total of 128 primiparas with breakthrough pain after epidural labor analgesia were randomly divided into four groups (R, C1, C2 and C3 groups). When breakthrough pain occurred, 0.15% ropivacaine 6 mL was injected epidural in the group R, and 1.5% chloroprocaine 6, 8 and 10 mL were injected epidural in the group C1, the group C2 and the group C3, respectively. The visual analogue score (VAS) for pain was assessed every 3 minutes after the administration of local anesthetics. The primary outcome was recorded including the onset time of breakthrough pain after the administration and the success rate of breakthrough pain treatment. Secondary outcome included rescue analgesia rate, maternal satisfaction (5 minutes after administration of breakthrough pain, 24 hours after the delivery), VAS, modified Bromage score, fetal heart rate (FHR) at first breakthrough pain (T0), 3 min (T1), 6 min (T2), 9min (T3), 12 min (T4), 15 min (T5) and 18 min (T6) after administration, the interval and duration of uterine contraction at the onset time of breakthrough pain, the second, fourth, sixth, eighth, tenth and twelfth contractions after administration, Apgar score in 1 and 5 min and adverse reactions. Results Kaplan-Meier survival analysis showed that the median onset time (95%CI) of breakthrough pain in the group R, the group C1, the group C2 and the group C3 were 14.3 (13.4-15.2) min, 6.6 (5.6-7.6) min, 5.9 (5.0-6.8) min and 4.7 (3.9-5.4) min, respectively. The onset time of administration was significantly faster in the group C3 than that in the group C1 and the group C2 (Log-rank χ² was 9.852 and 5.325, P＜0.05). Compared with the group R, the success rate of breakthrough pain treatment and maternal satisfaction (5 minutes after administration, 24 hours after the delivery) were significantly increased in the group C2 and the group C3, and remedial analgesia rate was significantly decreased in the group C3 (P < 0.01). Compared with the group C1, the success rate of breakthrough pain treatment was increased and the remedial analgesia rate was decreased in the group C3 Maternal satisfaction (5 minutes after administration, 24 hours after the delivery ) was significantly increased in the group C2 and the group C3 (P < 0.01). At T1, the VAS score was significantly lower in the group C2 and the group C3 than that in the group R, and which was significantly lower in the group C3 than that in the group C1 (P < 0.05). At T2-5, the VAS score was significantly lower in the group C1, the group C2 and the group C3 than that in the group R, and which was significantly lower in the group C2 and the group C3 than that in the group C1 (P < 0.05). At T6, VAS scores were significantly lower in the group C2 and the group C3 than those of the group R and the group C1 (P＜0.05). There were no significant differences in the interval of uterine contractions and duration of uterine contractions between the four groups. Compared with the group R and the group C1, the probability of lower limb numbness within 30 minutes after administration of breakthrough pain was significantly higher in the group C3 (P＜0.05). There were no significant differences in modified Bromage score, FHR at different time points before and after administration, and Apgar score at 1 and 5 min between the four groups. Conclusion The optimal effective dose of epidural injection of 1.5% chloroprocaine for the treatment of breakthrough pain during labor analgesia is 8 mL. [ABSTRACT FROM AUTHOR]

Background: Refractory angina pectoris (RAP) is a chronic, severe chest pain associated with coronary artery disease that cannot be resolved using optimal medical or surgical approaches. Spinal cord stimulation (SCS) is a suitable treatment option. Conventional waveforms of SCS have shown a potent effect on the tempering of RAP. However, SCS is associated with undesired paresthesia. The new burst SCS waveforms have been reported to have fewer adverse effects. Case: We reviewed a case in which RAP was successfully treated with burst SCS in a middle-aged male, with a tonic waveform employed for breakthrough pain as needed. Conclusions: Appropriate use of tonic and burst stimulations according to the symptoms is expected to maximize the effect of relieving chest pain induced by RAP. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of intranasal dexmedetomidine on preventing breakthrough pain of epidural labor analgesia. Methods Full-term primigravida with singleton fetus and ASA physical status Ⅰ or Ⅱ (n=100) were randomly assigned to control group and intranasal dexmedetomidine group (observation group). The 0.8 µg/kg of dexmedetomidine or equal volume normal saline were administered intranasally 20 minutes after epidural analgesia for observation group and control group, respectively. The incidence of breakthrough pain, the duration from epidural analgesia to the first onset of breakthrough pain, the frequency of patient controlled epidural analgesia (PCEA), the total dosage of analgesics, the maternal satisfaction with analgesia and the duration of labor phrase were recorded. The effect of intranasal dexmedetomidine on breakthrough pain of epidural labor analgesia was evaluated. The VAS scores, the Ramsay scores and FHR before epidural analgesia (T0), and after epidural analgesia at 1 h (T1), 2 h (T2), 3 h (T3), 4 h (T4), full cervical dilation (T5), fetal disengagement (T6), Apgar scores of neonates and umbilical artery blood gas analysis were recorded in the two groups to assess the effect of maternal and neonatal safety. Results A total of 91 parturients aged 20 to 36 years were included in this study. Compared with the control group (n=45), the incidence of breakthrough pain was significantly reduced, the duration from epidural analgesia to the first onset of breakthrough pain was significantly prolonged, the frequency of PCEA and the total dosage of analgesics was significantly reduced, the maternal satisfaction with analgesia was significantly increased, the VAS scores were significantly decreased at T1~3 and the Ramsay scores were significantly increased at T1~3 in the observation group (n=46, P＜0.05). There were no significant differences in the duration of labor phrase, FHR, Apgar scores of neonates, umbilical artery blood gas analysis and the adverse reactions between the two groups (P＞0.05). Conclusion Intranasal dexmedetomidine for epidural labor analgesia can reduce the incidence of breakthrough pain, delay the first onset of breakthrough pain, decrease the dosage of local anesthetic, and have no obvious adverse effects on parturients and newborns. [ABSTRACT FROM AUTHOR]