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1. Intrathecal Morphine for Analgesia After Postpartum Bilateral Tubal Ligation

Author

Holly A. Muir, Ashraf S. Habib, William D. White, Adeyemi J. Olufolabi, Tede E. Spahn, and Terrance W. Breen

Subjects
Adult, Sterilization, Tubal, Nausea, medicine.medical_treatment, Sedation, Anesthesia, Spinal, Fentanyl, Double-Blind Method, medicine, Humans, Saline, Injections, Spinal, Pain Measurement, Pain, Postoperative, Morphine, business.industry, Postpartum Period, Acetaminophen, Analgesics, Opioid, Anesthesiology and Pain Medicine, Anesthesia, Postoperative Nausea and Vomiting, Vomiting, Female, medicine.symptom, business, Oxycodone, medicine.drug
Abstract

Postpartum bilateral tubal ligation (PPBTL) causes postoperative pain. We designed this study to determine the efficacy of 50 μg intrathecal morphine for analgesia after PPBTL. Sixty-five women received spinal anesthesia with 12.75 mg hyperbaric bupivacaine, 20 μg of fentanyl, and either 50 μg of morphine (morphine group) or 0.05 mL of saline (control group). Postoperative analgesia was provided with regular naproxen 500 mg and oxycodone 5 mg/acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P = 0.003) and pain was less intense at rest (P = 0.008) and on movement (P < 0.0001) in the morphine group. There was no significant overall difference in nausea, pruritus, or sedation scores, but vomiting occurred more frequently in the morphine group (21.4% versus 3.5%; P = 0.052). In post hoc comparisons, pain at rest within the morphine group was significantly less at 4 h (P = 0.006), pain on movement was significantly less at 4 h (P = 0.002) and 12 h (P = 0.0004), and pruritus was significantly more frequent at 12 h (P = 0.002) compared with the control group. Oxycodone 5 mg/acetaminophen 325 mg mixture consumption was significantly smaller (P = 0.006) and the time to first request of analgesia was significantly longer (P = 0.006) in the morphine group. We conclude that the addition of 50 μg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provides improved postoperative analgesia in women undergoing PPBTL.

Published
2005
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2. In collaboration with the Canadian Anesthesiologists’ Society, the Canadian Journal of Anesthesia is proud to publish the best abstracts presented at the Annual Meeting of the Canadian Anesthesiologists’ Society held in Quebec City, Quebec, June 18–22, 2004

Author

David C. Campbell, Terrance W. Breen, Stephen Halpern, Holly Muir, Robert Nunn, H. Yang, K. Raymer, R. Butler, J. Parlow, R. Roberts, Rita Katznelson, Keyvan Karkouti, Mohammed Ghannam, Esam Abdelnaem, Jo Carroll, Stuart McCluskey, Terrence M. Yau, Jacek Karski, Gregory M. T. Hare, C. David Mazer, Xiamao Li, Rong Qu, May S. M. Cheung, Carla Coackley, Andrew J. Baker, Michael Ronayne, Dajun Song, Frances Chung, Barnaby Ward, Suntheralingam Yogendran, Carolyn Sibbick, Tejinder S. Chhina, Harry Lapierre, Zane S. Jackson, Howard M. Leong-Poi, Jerome M. Teitel, David A. Latter, Bradley H. Strauss, Peter L. Gross, Kong E. You-Ten, Valerie B. Caraiscos, Erin M. Elliot, Victor Y. Cheng, John F. MacDonald, Beverley A. Orsera, Richard Brail, Colin J. L. McCartney, Sherif Abbas, Hugo Nova, Regan Rawson, Vincent W. S. Chan, Joel Katz, Brent Graham, Dimitri Anastakis, and Herbert von Schroeder

Subjects
Anesthesiology and Pain Medicine, Jury, business.industry, Anesthesia, media_common.quotation_subject, Medicine, General Medicine, Editorial board, Patient controlled epidural analgesia, business, media_common
Abstract

tion by a member of the Society. The Richard Knill competition was instituted in memory of Dr. Richard Knill, a foremost researcher in anesthesiology and prominent collaborator to the Canadian Journal of Anesthesia (CJA). The Annual Meeting Committee selects the top abstracts submitted for presentation by members of the Society at the Annual Meeting. The authors are invited to present their results at the Richard Knill competition. Presentations are marked by a jury composed of the members of the Editorial Board of the CJA. In 2004, the Richard Knill Award was presented to Dr. David C. Campbell for his work on Patient Controlled Epidural Analgesia during labour.

Published
2004
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3. Abstract

Author

Tejinder S. Chhina, Harry Lapierre, Zane S. Jackson, Howard M. Leong-Poi, Jerome M. Teitel, David A. Latter, Bradley H. Strauss, Peter L. Gross, C. David Mazer, Richard Brull, Colin J. L. McCartney, Sherif Abbas, Hugo Nova, Regan Rawson, Vincent W. S. Chan, Joel Katz, Brent Graham, Dimitri Anastakis, Herbert von Schroeder, Alexandre Lallo, Pierre Drolet, Mélanie Lacroix, Kong E. You-Ten, Valerie B. Caraiscos, Erin M. Elliot, Victor Y. Cheng, John F. MacDonald, Beverley A. Orser, Bertrand Lau, Ban C. H. Tsui, Heather L. Mollison, William P. S. McKay, Rajesh Patel, Vance Chow, October Negraeff, Rana Karam, H. Yang, K. Raymer, R. Butler, J. Parlow, R. Roberts, David C. Campbell, Terrance W. Breen, Stephen Halpern, Holly Muir, Robert Nunn, Rita Katznelson, Keyvan Karkouti, Mohammed Ghannam, Esam Abdelnaem, Jo Carroll, Stuart McCluskey, Terrence M. Yau, Jacek Karski, Gregory M. T. Hare, Xiamao Li, Rong Qu, May S. M. Cheung, Carla Coackley, Andrew J. Baker, Michael Ronayne, Dajun Song, Frances Chung, Barnaby Ward, Suntheralingam Yogendran, Carolyn Sibbick, Lisa C. Silcox, Ted L. Ashbury, Brian Milne, Elizabeth G. VanDen Kerkhof, Pamela J. Morgan, Doreen Cleave-Hogg, Susan DeSousa, Louie Wang, Jelka Lujic, Niamh I. Donnelly, Clint J. Torok-Both, Barry Finegan, Michael J. Jacka, Barry A. Finegan, Rajiv Chawla, Ravi K. Agrawal, Mahendra Kumar, David H. Goldstein, James E. Paul, Monakshi Sawhney, W. Scott Beattie, Richard F. McLean, Joel L. Parlow, Deborah A. Tod, Dmitri Souzdalnitski, Elena Sourovtseva, Donald Livingstone, Gil Faclier, Jason Sawyer, Joseph Kay, Arsenio Avila, Mrinalini Balki, Pirjo H. Manninen, Karolinah Lukitto, Michael B. Lukins, Keya Quader, Munisha Agarwal, Rakhi Kawatra, J. S. Dali, Peter H. Mak, Geraldine Jose, Sean R. Hall, Murray Hong, Ivan L. Rapchuk, Karen Loo, Alain Deschamps, Asaha Suzuki, Akifumi Kanai, Sumio Hoka, Anthony M. -H. Ho, Manoj K. Karmakar, Anna Lee, Winnie Samy, Jie Yi, Paul B. S. Lai, Amy Cho, E. Stockton, S. Gowrie-Mohan, P. U. Ramanayake, S. Jothilingam, Ali Mirmansouri, Alese M. Wagner, Kirsten Cunningham, Shirley Perry, Sunil Desai, Clint Torok-Both, Kathryn DeKoven, Paul Brousseau, Orlando Hung, Adam Law, Derek Levangie, Ronald Cheverie, Karen M. Caputo, Robert Byrick, Martin Chapman, Kim Vicente, Glen Atlas, Josiane Léveillé, Dany Côté, Julie Soucy, Jean S. Bussières, Duminda N. Wijeysundera, George Djaiani, Vivek Rao, Michael A. Borger, Robert J. Cusimano, Anoush D. Moghadam, Abtin Heydarzadeh, Ashraf A. Fayad, Homer Yang, Elizabeth Ling, Paul K. Tenenbein, Doug Maguire, Roland Debrouwere, Peter C. Duke, Stephen E. Kowalski, Devashish Chakravarty, Jean-Yves Dupuis, Howard Nathan, Fraser Rubens, Roy Masters, Paul Hendry, Thierry Mesana, Hyun Ju Jung, Dmitri Chamchad, Valerie Arkoosh, Duminda Wijeysundera, Chris Chan, Kathleen Datillo, Joan Ivano, Cantwell Clark, Reed D. Quinn, John H. Braxton, Andreas H. Taenzer, Kristen M. Sullivan, Osama A. Al-Abdulhadi, Diane R. Biehl, Bill Y. Ong, Abdulaziz Boker, Kristine I. Stewart, Susan A. Shaw, Jeong-Yeon Hong, Susan K. Palmer, Rose Kung, Stephen H. Halpern, Jennifer A. Yee, Eric Goldszmidt, Crystal Chettle, Ralph Kern, Kristi Downey, Isabella Devito, Alison Macarthur, Niall L. Purdie, Pamela J. Angle, Christine Kurtz-Landy, David Streiner, Cathy Charles, Jo Watson MacDonnell, Desmond Lam, Lie Ming Lie, Jean E. Kronberg, Dorothy E. Thompson, Haiheng Dong, Ayman Hyder, Qinghua Wang, Wei-Yang Lu, Ngozi N. Imasogie, Atul Prahbu, Bruna Curti, Zoya Potyomkina, Matthew R. Belmont, Joseph Tjan, Cynthia A. Lien, Sanjay Patel, Charles Imarengiaye, Javad Peirovy, Reginald Edward, Frances F. Chung, Leonid Kayumov, David R. Sinclair, Henry J. Moller, Colin M. Shapiro, Guillaume Michaud, Guillaume Trager, Stephane Deschamps, Thomas M. Hemmerling, Janet Hsu, Patrick Cheng, John T. Granton, Alan D. Baxter, Salmaan Kanji, Adam D. Oxner, Karen J. Buth, Gregory M. Hirsch, Claudio DiQuinzio, Kristine A. Hirsch, A. Denault, P. Couture, M. Carrier, A. Fortier, D. Babin, J. C. Tardif, Jean-François Olivier, Fadi Basile, Ignatio Prieto, Nhiên Lê, Yuji Hirasaki, Patricia Murphy, Karen McRae, Thomas Waddell, Shaf Keshavjee, Peter Slinger, Adriaan Van Rensburg, Terry M. Yau, Eric Yeo, David Sutton, Michael Borger, Gilbert Blaise, Marius D. Gangal, Lan Gao, Stuart A. McCluskey, Wing Cheung, Bobby Metha, Humara Poonwala, Ludwik Fedorko, Johnson R. Symon, Mark D. Peterson, Carl C. P. Leipoldt, Michelle Clunie, William P. S. Mckay, Grant Miller, Joanne Guay, Louise Lortie, Soochang Son, Yunhee Kim, Toshimi Arai, Masao Yamashita, Denise Rohan, Ross Barlow, Sean J. Barbour, J. Mark Ansermino, Christine A. Vandebeek, Rangamani K. Raman, Nao Nakatsuka, Carolyne J. Montgomery, Erik D. Skarsgard, Colleen A. Court, James S. Galton, Mark W. Crawford, Basem Naser, Clifford Carter, Richard Liu, Andrew G. Usher, Dominic A. Cave, Cathy Tang, Jason A. Hayes, and Juliana M. Tan

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
2004
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4. Combined spinal-epidural analgesia for labor

Author

Terrance W. Breen

Subjects
Bupivacaine, medicine.medical_specialty, Side effect, Continuous infusion, business.industry, Intrathecal, Epidural space, Surgery, Fentanyl, Sufentanil, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Combined spinal epidural, Anesthesia, medicine, business, medicine.drug
Abstract

Combined spinal-epidural analgesia is a technique that provides rapid-onset, profound epidural analgesia for laboring parturients at almost any stage of labor. The most commonly used technique is a needle-through-needle technique in which the epidural space is identified with an epidural needle, and then a long spinal needle is inserted through the epidural needle and into the cerebrospinal fluid. Intrathecal fentanyl, 15 to 25 μg ± 1 to 2.5 mg of bupivacaine, or 2.5 to 5 μg of sufentanil ± 1 to 2.5 mg of bupivacaine are injected to produce analgesia. The epidural needle is removed and an epidural catheter inserted. Analgesia is maintained by low-dose, patient-controlled epidural analgesia; continuous infusion epidural analgesia; or intermittent top-ups. Pruritus is a very common side effect. Respiratory depression is rare but of great concern. Current literature favors low-dose epidural analgesia in labor as leading to the best patient and obstetric outcomes. Both low-dose conventional epidural analgesia and combined spinal-epidural analgesia produce similar outcomes. The main advantage of combined spinal-epidural analgesia is its predictable profound analgesia in parturients during late labor or when labor is progressing rapidly. Copyright © 2001 by W.B. Saunders Company

Published
2001
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5. The changing role of magnesium sulphate therapy

Author

Terrance W. Breen and Theresa Yang

Subjects
Drug, Eclampsia, business.industry, Magnesium, media_common.quotation_subject, chemistry.chemical_element, medicine.disease, female genital diseases and pregnancy complications, Stopped before completion, Anesthesiology and Pain Medicine, chemistry, Anesthesia, Tocolytic, Medicine, Neonatal death, business, reproductive and urinary physiology, media_common
Abstract

Magnesium sulphate is not an effective tocolytic. Magnesium sulphate therapy was also linked to preterm neonatal deaths in one study, which was stopped before completion. Other studies suggest a possible neuroprotective effect of magnesium. Both of these issues require further study. Magnesium sulphate is clearly the drug of choice to prevent recurrent eclampsia and to treat severe pre-eclampsia.

Published
1999
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6. Abstracts

Author

Cristina Hurtado, John Bradley, Andrew R. Burns, Keyvan Karkouti, Rob Anderson, Simon D. Abrahamson, C. David Mazer, O. R. Hung, L. Comeau, Joseph A. Fisher, Janet Tessler, Joshua Rucker, Alix Mathicu, Sara Murray-Foster, Chou Tz-Chong, Li Chi-Yuan, Takako Tsuda, Akihiko Tabuchi, Hiroshi Sasano, Masanobu Kiriyama, Akinori Okada, Junichiro Hayano, Akinori Takeuchi, Hirotada Katsuya, Claude P. Tousignant, Elizabeth Ling, Ramiro Arellano, N. Dowd, J. Karski, D. Cheng, J. Carroll-Munro, D. K. Rose, C. O. Mazer, M. M. Cohen, D. Wigglesworth, William P. S. McKay, Robert J. Teskey, Julio Militzer, Guy Kember, Travis Blanchet, Peter H. Gregson, Steven R. Howells, James A. Robblee, Terrance W. Breen, Laura Dierenfield, Tacie McNeil, Donna J. Nicholson, Stephen E. Kowalski, G. Andrew Hamilton, Michael P. Meyers, Carl Serrette, Peter C. Duke, Ingrid Custeau, Rend Martin, Sonia Larabée, Martine Pirlet, Madeleine Pilote, Jean-Pierre Tetrault, Ban C. H. Tsui, Sunil Gupta, Brendan Finucane, Mitchell J. Weisbrod, Vincent W. S. Chan, Z. Kaszas, C. Dragomir, M. R. Cohen, M. Gandhi, A. S. Clanachan, B. A. Finegan, Lisa Isaac, William M. Splinter, L. A. Hall, H. M. Gould, E. J. Rhine, Lyne Bergeron, Michel Girard, Pierre Drolet, Hong Hanh Le Truong, Carl Boucher, Daniel Vézina, Martin R. Lessard, Marie Gourdeau, Claude A. Trépanier, Theresa Yang, Alison Macarthur, P. Chouinard, F. Fugère, M. Ruel, Pekka Tarkkila, Marja Silvasti, Marjatta Tuominen, Nils Svartling, Per H. Rosenberg, David M. Bond, John F. Rudan, Michael A. Adams, Brian K. Tsang, Wanda Keahey, Lucia Gagliese, Marla Jackson, Paul Ritvo, Adarose Wowk, Alan N. Sandler, Joel Katz, J. G. Laffey, J. F. Boylan, Neal H. Badner, Wendy E. Komar, R. A. Cherry, S. M. Spadafora, R. J. Butler, Fiona McHardy, Joanne Fortier, Frances Chung, Scott Marshall, Ananthan Krishnathas, Jean Wong, Ewan Ritchie, Andrew Meikle, Nicole Avery, Janet van Vlymen, Joel L. Parlow, David Sinclair, Gabor Mezei, Fengling Jin, Andrew Norris, Tharini Ganeshram, Bernard A. MacLeod, Aliréza Azmudéh, Luigi G. Franciosi, Craig R. Ries, Stephan K. W. Schwarz, William PS McKay, Benjamin W. S. McKay, Pascal Meuret, Vincent Bonhomme, Gilles Plourde, Pierre Fiset, Stevens B. Backman, Alex Vesely, Leeor Sommer, Joel Greenwald, Elana Lavine, Steve Iscoe, George Volgyesi, Ludwik Fedorko, Joseph Fisher, Emilio B. Lobato, Cheri A. Sulek, Laurie K. Davies, Peter F. Gearen, François Bellemare, François Donati, Jacques Couture, Hwan S. Joo, Sunil Kapoor, Shahriar Shayan, Kenneth M. LeDez, Jim Au, John H. Tucker, Edwin B. Redmond, V. Gadag, Catherine Penney, Gregory M. T. Hare, Timothy D. G. Lee, Gregory M. Hirsch, Fan Yang, Eric Troncy, Gilbert Blaise, Yoshiyuki Naito, Shoji Arisawa, Masahiro Ide, Susumu Nakano, Kazuo Yamazaki, Takae Kawamura, Noriko Nara, Reiji Wakusawa, Katsuya Inada, Robert J. Hudson, Karanbir Singh, Gary A. Harding, Blair T. Henderson, Ian R. Thomson, Christopher G. Wherrett, Donald R. Miller, Alan A. Giachino, Michelle A. Turek, Kelly Rody, H. Vaghadia, V. Chan, S. Ganapathy, A. Lui, J. McKenna, K. Zimmer, William D. Regan, Ross G. Davidson, Krista Nevin, Sergio Escobedo, E. Mitmaker, M. J. Tessler, K. Kardash, S. J. Kleiman, M. Rossignol, L. Kahn, F. Baxter, A. Dauphin, C. Goldsmith, P. Jackson, J. McChesney, J. Miller, L. Takeuchi, E. Young, Kristine Klubien, Edith Bandi, Franco Carli, Kathleen Dattilo, Doris Tong, Mohit Bhandari, Louise Mazza, Linda Wykes, L. Z. Sommer, J. Rucker, A. Veseley, E. Levene, Y. Greenwald, G. Volgyesi, L. Fedorko, S. Iscoe, J. A. Fisher, Guo-Feng Tian, Andrew J. Baker, F. X. Reinders, A. J. Baker, R. J. Moulton, J. I. M. Brown, L. Schlichter, Laurence Van Tulder, Stéphane Carignan, Julie Prénovault, Jean-Paul Collet, Stan Shapiro, Jean-Gilles Guimond, Louis Blait, Thierry Ducruet, Martin Francœur, Marc Charbonneau, Guy Cousineau, Daniel R. Wong, Michele McCall, Fergus Walsh, Regina Kurian, Mary Keith, Michael J. Sole, Kursheed N. Jeejeebhoy, E. Whitten, P. H. Norman, J. A. Aucar, L. A. Coveler, Rodney M. Solgonick, Y. Bastien, Bruce Mazer, Koji Lihara, Beverley A. Orser, Michael Tymianski, Brendan T. Finucane, Nuzhat Zaman, Ibrahim Kashkari, Soheir Tawfik, Yun K. Tarn, Peter D. Slinger, Karen McRae, Timothy Winton, Alan N. Sandier, J. E. Zamora, Mary Jane Salpeter, Donglin Bai, John F. MacDonald, Kelly Mayson, Ed Gofton, Keith Chambers, Susan E. Belo, J. Colin Kay, Sean R. R. Hall, Louie Wang, Brian Milne, Chris Loomis, Zhi He, Wichai Wougchanapai, Ing K. Ho, John H. Eichhorn, Tangeng Ma, Wichai Wongchanapai, John H. Eicnhorn, Damian B. Murphy, M. B. Murphy, Steven B. Backman, Reuben D. Stein, Brian Collier, Canio Polosa, Chi-Yuan Li, Tz-Chong Chou, Jia-Yi Wang, John Fuller, Ronald Butler, Salvatore Spadafora, Neil Donen, Laurence Brownell, Sandy Shysh, Keith Carter, Chris Eagle, Isabella Devito, Stephen Halpern, J. Hugh Devitt, Doreen A. Yee, John L. deLacy, Donald C. Oxorn, Gary F. Morris, Raymond W. Yip, M. G. Gregoret-Quinn, R. F. Seal, LJ. Smith, A. B. Jones, C. Tang, B. J. Gallant, L. A. Nadwidny, Gerald V. Goresky, Tara Cowtan, Hilary S. Bridge, Carolyne J. Montgomery, Ross A. Kennedy, Pamela M. Merrick, M. Yamashita, K. Wada, Sylvie LeMay, Jean-François Hardy, Pamela Morgan, Steven Halpern, Jana Evers, P. Ronaldson, F. Dexter, Desmond Writer, Holly Muir, Romesh Shukla, Rob Nunn, John Scovil, Jeremy Pridham, Ola Rosaeg, Allan Sandier, Patricia Morley-Foster, Simon Lucy, Lesley-Ann Crone, Karen Zimmer, Deborah J. Wilson, Robert Heid, M. Joanne Douglas, Dan W. Rurak, Anna Fabrizi, Chantal T. Crochetière, Louise Roy, Edith Villeneuve, Louise Lortie, Sandra Katsiris, Barbara Leighton, Donna Wilson, Jean Kronberg, Leszek Swica, Janet Midgley, Robert Nunn, Bruce Smith, Michael E. Rooney, David C. Campbell, Celina M. Riben, Ray W. Yip, Jo MacDonell, and Tracey Levine

Subjects
Sevoflurane, Anesthesiology and Pain Medicine, Morphine, Total Knee Arthroplasty, Pulmonary Capillary Wedge Pressure, Ropivacaine, General Medicine, Article
Published
1998

7. Abstracts

Author

Brian P. Kavanagh, Cuong Ngo, Karen Raymer, Homer Yang, Jamal A. Alhashemi, Anne C. P. Lui, Dennis Reid, Nicholas Cicutti, Barbra Krepski, Gordon Wood, Daren K. Heyland, Neal H. Badner, John M. Murkin, Jim Mohr, F. Neil McKenzie, Peter J. A. van der Starre, W. T. van Rooyen-Butijn, Kristine Wilson-Yang, Kevin Teoh, R. M. K. W. Lee, Imtiaz Hossain, Davy Cheng, Jacek Karski, Buvanendran Asokumar, Alan Sandier, Marc A. St-Amand, Alan H. Menkis, Donal B. Downey, William Nantau, Sandy Adams, Noreen Dowd, David Wong, Jo Carroll-Munro, Clare Trachuk, N. Cregg, D. C. H. Cheng, W. G. Williams, J. M. Karski, S. Siu, G. Webb, Davy C. H. Cheng, David T. Wong, Rafal Kustra, Robert J. Tibshirani, Dany L. Côté, David E. Lacey, Kenneth M. LeDez, Julia A. Smith, Edward T. Crosby, Fredrick K. Orkin, A. Fisher, G. Volgyesi, J. Silverman, S. Edelstein, J. Rucker, L. Sommer, S. Dunington, L. Roy, C. Crochetière, M. -Y. Arsenault, E. Villeneuve, L. Lortie, Caroline S. Grange, M. Joanne Douglas, Timothy J. Adams, Pamela M. Merrick, S. Brian Lucas, Pamela J. Morgan, Stephen Halpern, Jason Lo, Carolyn L. Giesinger, Stephen H. Halpern, Terrance W. Breen, Srigowri Vishnubala, Geeta R. Shetty, M. De Kock, A. Lagmiche, J. L. Scholtes, Wlodzimierz Grodecki, Peter J. Duffy, Kathryn A. Hull, Geoffrey S. Hawboldt, Alexander J. Clark, J. Bruce Smith, Richard W. Norman, W. Scott Beattie, A. Sandier, M. Jewett, L. Valiquette, J. Katz, Y. Fradet, D. Redelmeier, H. Sampson, Jeff Cole, Todd Chedore, Walter Snedden, Robert G. Green, Mitchel B. Sosis, Philip I. Robles, Edward R. Lazar, Donald T. Jolly, Yun K. Tarn, Soheir R. Tawfik, Alexander S. Clanachan, Avaleigh Milne, Travis Beamish, D. J. Cuillerier, M. D. Sharpe, J. K. Lee, M. Basta, A. D. Krahn, G. J. Klein, R. Yee, Narendra Vakharia, Heather Francis, Louis Scheepers, Himat Vaghadia, Joanne Carrier, René Martin, Marline Pirlet, Yves Claprood, Jean-Pierre Tétrault, T. D. Wong, L. Ryner, P. Kozlowski, G. Scarth, R. K. Warrian, G. Lefevre, D. Thiessen, L. Girling, L. Doiron, C. McCudden, J. Saunders, W. A. C. Mutch, Stéphan Langevin, Martin R. Lessard, Claude A. Trépanier, Gregory M. T. Hare, Johnson C. S. Ngan, Dan Viskari, A. Berrill, Christian Jodoin, Jacques Couture, François Bellemare, Stephen Farmer, Holly Muir, Phyllis Money, Brian Milne, Joel Parlow, Jennifer Raymond, Julie M. Williams, Rosemary A. Craen, Teresa Novick, Wendy Komar, Luc Frenette, Jerry Cox, B. Lockhart, P. McArdle, D. Eckhoff, S. Bynon, Wojciech B. Dobkowski, David R. Grant, William J. Wall, Edgar G. Chedrawy, Richard I. Hall, Vivian Nedelcu, Jean-Paul Viale, Gérard Bégou, Pierre Sagnard, Richard Hughson, Luc Quintin, Éric Troncy, Jean-Paul Collet, Stan Shapiro, Jean-Gilles Guimond, Louis Blair, Thiérry Ducruet, Martin Francœur, Marc Charbonneau, Gilbert Blaise, W. Snedden, E. Bernadska, H. I. Manson, Juditli L. Kutt, Beruie Y. Mezon, Osamu Nishida, Ramiro Arellano, Patty Boylen, Wilfred DeMajo, David P. Archer, Sheldon H. Roth, Sitaram Raman, Pirjo Manninen, Kevin Boyle, Aleksa Cenic, Ting-Yim Lee, Adrian W. Gelb, F. X. Reinders, J. I. M. Brown, A. J. Baker, R. J. Moulton, L. Schlichtert, Stephan K. W. Schwarz, Ernest Puil, Barry A. Finegan, Brendan T. Finucane, Matt M. Kurrek, J. Hugh Devitt, Doreen Cleave-Hogg, John Bradley, Robert Byrick, Salvatore M. Spadafora, John G. Fuller, Mark H. Gelula, Kelly Mayson, Bruce Forster, R. J. Byrick, D. J. McKnight, M. Kurrek, M. Kolton, D. Cleave-Hogg, J. Haughton, S. Halpern, J. Kronberg, Sandy Shysh, Chris Eagle, A. Joel Dagnone, Joel L. Parlow, G. Blaise, F. Yang, H. Nguyen, E. Troncy, G. Czaika, Ireneusz Wachowski, Hervé Deladrière, Chantal Cambier, Philippe Pendeville, O. R. Hung, E. Coonan, S. C. Whynot, M. Mezei, Anthony M. -H. Ho, Ingrid S. Luchsinger, Elizabeth Ling, Doreen Mashava, Herbert M. Chinyanga, Marsha M. Cohen, Melissa Shaw, J. A. Robblee, R. S. Labow, F. D. Rubens, A. M. Diemunsch, R. Gervais, D. K. Rose, M. M. Cohen, L. O’Brien-Pallas, C. Copplestone, K. Karkouti, K. Sykora, Shirley L. W. Cheung, Peter D. Booker, Roger Franks, Marco Pozzi, Beverley Guard, Nancy Sikich, Jerrold Lerman, Mark Levine, Hilton Swan, Peter Cox, Carolyne Montgomery, Gillian Dunn, Russell Bourne, Anna Kinahan, James McCormack, Gillian S. Dunn, Eleanor J. Reimer, Peter Sanderson, Peter M. Sanderson, Carolyne J. Montgomery, Terri A. Betts, Guy R. Orlay, David H. Wong, Marsha Cohen, A. A. Al-Kaisy, V. Chan, P. Peng, A. Perlas, A. Miniad, Edward V. Cushing, Keith R. Mills, Hossam El-Beheiry, Shokrollah S. Jahromi, John Weaver, Mary Morris, Peter L. Carien, Robert McTaggart Cowan, Jonathan Richards, Blair T. Henderson, Robert J. Hudson, Ian R. Thomson, Michael Moon, Mark D. Peterson, Morley Rosenbloom, Patrick J. Davison, Mohamed Ali, Naheed S. Ali, Norman R. Searle, Ian Thomson, Micheline Roy, Line Gagnon, A. Lye, F. Walsh, W. Middleton, D. Wong, A. Langer, L. Errett, C. D. Mazer, Karin M. Williamson, Graham Smith, Kandiah P. Gnanendran, S. J. Bignell, S. Jones, J. Sleigh, M. Arnell, Jan-Ake I. Schultz, David W. Fear, S. Ganapathy, C. Moote, R. Wassermann, J. Watson, K. Armstrong, Aznif Ozsolak Calikyan, Oya Yilmaz, Yildiz Kose, Philip Peng, Vincent Chan, Frances Chung, Andrew R. Claxton, Ananthan Krishnathas, Gabor Mezei, Terri L. Paul, Jacqueline A. Doyle, Mahesh Mehta, Luiz G. R. DeLima, Lucia E. O. Silva, Warren L. May, Roy J. Maliakkal, Richard Kolesar, Sara Rafuse, Mary Fletcher, Geoffrey Dunn, Michael Curran, Paul Bragg, Wayne Chamberlain, MaryLou Crossan, H. Sandhu, S. Spadafora, R. Mian, B. Evans, L. Hurst, and S. Katsiris

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1997
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8. Adding Fentanyl 0.0002% to Epidural Bupivacaine 0.125% Does Not Delay Gastric Emptying in Laboring Parturients

Author

Gordon H. Fick, Donald L. Zimmermann, and Terrance W. Breen

Subjects
Adult, medicine.medical_specialty, Adolescent, medicine.drug_class, Fentanyl, Absorption, Bolus (medicine), Pregnancy, medicine, Humans, Anesthetics, Local, Acetaminophen, Bupivacaine, Labor, Obstetric, Gastric emptying, Local anesthetic, business.industry, Area under the curve, Venous blood, Surgery, Analgesia, Epidural, Analgesics, Opioid, Drug Combinations, Anesthesiology and Pain Medicine, Gastric Emptying, Anesthesia, Analgesia, Obstetrical, Female, business, medicine.drug
Abstract

Previous studies have shown that bolus doses of fentanyl (50 and 100 micrograms) with epidural bupivacaine delay gastric emptying by up to 45 min. We studied the effect of the addition of small-dose fentanyl to epidural bupivacaine infusions on gastric emptying during labor. The acetaminophen absorption technique was used to infer gastric emptying. Twenty-eight patients in established labor consented to participate in the study. They were randomized to receive either 1) 10 mL bupivacaine 0.125% followed by an infusion of 0.125% bupivacaine at 10 mL/h or 2) 10 mL bupivacaine 0.125% with 50 micrograms fentanyl followed by an infusion of 0.125% bupivacaine and 0.0002% fentanyl at 10 mL/h. Two hours after initiation of epidural analgesia, each patient ingested 20 mg/kg acetaminophen in a suspension of 150 mL water. Venous blood samples were drawn for a baseline and then every 15 min for 2 1/2 h. There were no significant demographic differences between the groups. There were no differences detected between groups in the peak plasma concentrations of acetaminophen, the time to achieve the peak plasma concentrations, or the area under the curve at 45 and 90 min. Our results indicate that epidural infusions for labor analgesia using 0.125% bupivacaine and 0.0002% fentanyl do not delay gastric emptying compared to infusions of bupivacaine 0.125% alone.

Published
1996
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9. Factors Associated with Back Pain after Childbirth

Author

Phillppa A. Groves, Nancy E. Oriol, Terrance W. Breen, and Bernard J. Ransil

Subjects
Adult, Anesthesia, Epidural, medicine.medical_specialty, Pregnancy, Risk Factors, medicine, Back pain, Anesthesia, Obstetrical, Humans, Childbirth, Prospective Studies, Prospective cohort study, reproductive and urinary physiology, Post partum, Obstetrics, business.industry, Incidence, Incidence (epidemiology), Body Weight, Postpartum Period, Age Factors, medicine.disease, Body Height, Anesthesiology and Pain Medicine, Back Pain, Regression Analysis, Female, Pain catastrophizing, medicine.symptom, business, Postpartum period
Abstract

Back pain after childbirth is a frequent complaint. The purpose of this study was to determine the incidence of back pain 1-2 months post partum and to identify the factors, including epidural anesthesia for labor and delivery, that may predispose to it.Women delivering a viable singleton infant were interviewed 12-48 h after delivery for a history of back pain that occurred before, during, or both before and during the recent pregnancy and for details of their delivery experience. Two months later, the women interviewed were sent a follow-up questionnaire regarding the occurrence of back pain 1-2 months post partum.Follow-up data were available for 1,042 (88%) of the 1,185 women originally interviewed. The incidence of post partum back pain in women who received epidural anesthesia was equivalent to those who did not (44% vs. 45%). Through stepwise multiple logistic regression, post partum back pain was found to be associated with a history of back pain, younger age, and greater weight. However, new-onset post partum back pain was found to be associated with greater weight and shorter stature. No statistically significant association was found between post partum back pain and epidural anesthesia, number of attempts at epidural placement, duration of second stage of labor, mode of delivery, or birth weight.The overall incidence of back pain 1-2 months post partum in this population was 44%. Predisposing factors were a history of back pain, younger age, and greater weight. Predisposing factors for new-onset post partum back pain were greater weight and shorter stature. Epidural anesthesia for labor and delivery did not appear to be associated with back pain 1-2 months post partum.

Published
1994
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10. Drugs and techniques in obstetric anesthesia

Author

Terrance W. Breen and Nancy E. Oriol

Subjects
Pregnancy, medicine.medical_specialty, Fetal surgery, Systemic lupus, business.industry, medicine.medical_treatment, General surgery, Disease, Obstetric anesthesia, medicine.disease, Anesthesiology and Pain Medicine, immune system diseases, Anesthesia, medicine, skin and connective tissue diseases, business, Laparoscopic cholecystectomy
Abstract

The relationship between pregnancy and co-existing disease as pertains to drugs and techniques is reviewed. New advances in systemic lupus erythematosis (SLE), laparoscopic cholecystectomy and maternal outcome after fetal surgery are summarized. Further information concerning difficult intubations a

Published
1992
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11. Pulmonary hypertension and cardiomyopathy: anaesthetic management for Caesarean section

Author

James A. Janzen and Terrance W. Breen

Subjects
Anesthesia, Epidural, Cardiomyopathy, Dilated, medicine.medical_specialty, Adolescent, Lidocaine, Hypertension, Pulmonary, medicine.medical_treatment, Pregnancy Complications, Cardiovascular, Cardiomyopathy, Fentanyl, Pregnancy, Anesthesiology, medicine, Anesthesia, Obstetrical, Humans, Caesarean section, Fetus, Cesarean Section, business.industry, General Medicine, medicine.disease, Pulmonary hypertension, Surgery, Anesthesiology and Pain Medicine, Anesthesia, Female, business, medicine.drug
Abstract

Pulmonary hypertension in pregnant women is uncommon but is associated with a high mortality. We present the case of a 14-yr-old parturient with pulmonary hypertension and cardiomyopathy who required a Caesarean section. Management goals included: (1) maintaining right ventricular function, (2) avoiding the haemodynamic effects of general endotracheal anaesthesia, and (3) minimizing narcotic-related neonatal respiratory depression. While most authors agree on invasive pulmonary and systemic monitoring, opinions differ as to the optimal method of providing anaesthesia for these patients. The successful use of lumbar epidural anaesthesia with lidocaine and fentanyl is described. When the local anaesthetic was administered slowly and in increments, epidural anaesthesia was safe for both mother and fetus.

Published
1991
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14. Intrathecal opioids for combined spinal-epidural analgesia during labour

Author

Terrance W. Breen and Peter Deballi

Subjects
Anesthesia, Epidural, medicine.medical_specialty, Analgesic, Context (language use), Anesthesia, Spinal, Fentanyl, Sufentanil, Pregnancy, medicine, Anesthesia, Obstetrical, Humans, Pharmacology (medical), Intensive care medicine, Adverse effect, Injections, Spinal, Bupivacaine, Clinical Trials as Topic, Labor, Obstetric, business.industry, Pregnancy Outcome, Fetal Bradycardia, Analgesics, Opioid, Psychiatry and Mental health, Opioid, Anesthesia, Female, Neurology (clinical), business, medicine.drug
Abstract

In

Published
2003

15. A multicenter, randomized, controlled trial comparing bupivacaine with ropivacaine for labor analgesia

Author

Robert Nunn, Stephen H. Halpern, David Campbell, Holly A. Muir, Terrance W. Breen, Jean E. Kronberg, and Gordon H. Fick

Subjects
Adult, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Analgesic, Oxytocin, law.invention, Fentanyl, Randomized controlled trial, Double-Blind Method, law, Pregnancy, medicine, Humans, Ropivacaine, Anesthetics, Local, Pain Measurement, Bupivacaine, Local anesthetic, business.industry, Cesarean Section, Infant, Newborn, Pregnancy Outcome, Nerve Block, Delivery, Obstetric, Amides, Surgery, Anesthesiology and Pain Medicine, Patient Satisfaction, Anesthesia, Nerve block, Apgar Score, Analgesia, Obstetrical, Apgar score, Female, business, medicine.drug
Abstract

Background A meta-analysis of studies comparing high doses of bupivacaine with ropivacaine for labor pain found a higher incidence of forceps deliveries, motor block, and poorer neonatal outcome with bupivacaine. The purpose of this study was to determine if there is a difference in these outcomes when a low concentration of patient-controlled epidural bupivacaine combined with fentanyl is compared with ropivacaine combined with fentanyl. Methods This was a multicenter, randomized, controlled trial, including term, nulliparous women undergoing induction of labor. For the initiation of analgesia, patients were randomized to receive either 15 ml bupivacaine, 0.1%, or 15 ml ropivacaine, 0.1%, each with 5 microg/ml fentanyl. Analgesia was maintained with patient-controlled analgesia with either local anesthetic, 0.08%, with 2 microg/ml fentanyl. The primary outcome was the incidence of operative delivery. We also examined other obstetric, neonatal, and analgesic outcomes. Results There was no difference in the incidence of operative delivery between the two groups (148 of 276 bupivacaine recipients vs. 135 of 279 ropivacaine recipients; P = 0.25) or any obstetric or neonatal outcome. The incidence of motor block was significantly increased in the bupivacaine group compared with the ropivacaine group at 6 h (47 of 93 vs. 29 of 93, respectively; P = 0.006) and 10 h (29 of 47 vs. 16 of 41, respectively; P = 0.03) after injection. Satisfaction with mobility was higher with ropivacaine than with bupivacaine (mean +/- SD: 76 +/- 23 vs. 72 +/- 23, respectively; P = 0.013). Satisfaction for analgesia at delivery was higher for bupivacaine than for ropivacaine (mean +/- SD: 71 +/- 25 vs. 66 +/- 26, respectively; P = 0.037). Conclusions There was no difference in the incidence of operative delivery or neonatal outcome among nulliparous patients who received low concentrations of bupivacaine or ropivacaine for labor analgesia.

Published
2003

16. ASA PHYSICAL STATUS CLASSIFICATION - A PREGNANT PAUSE

Author

Tede E. Spahn, S. Millar, Adeyemi J. Olufolabi, Holly A. Muir, S. Drysdale, John R. Schultz, Terrance W. Breen, Ashraf S. Habib, P. Dwane, and Atilio Barbeito

Subjects
Pregnancy, medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Obstetrics, Medicine, business, medicine.disease
Published
2002
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19. EPIDURAL ROPIVACAINE VS. BUPIVACAINE: OBSTETRIC OUTCOMES

Author

Stephen H. Halpern, Robert Nunn, Terrance W. Breen, Jean E. Kronberg, Gordon H. Fick, Holly A. Muir, and David Campbell

Subjects
Bupivacaine, Anesthesiology and Pain Medicine, Ropivacaine, business.industry, Anesthesia, medicine, business, medicine.drug
Published
2001
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20. Obstetric anesthesia practice in Canada

Author

Laura Dierenfield, Tacie McNeil, and Terrance W. Breen

Subjects
medicine.medical_specialty, Canada, Epidural needles, business.industry, Clinical Laboratory Techniques, Pain medicine, Professional Practice, General Medicine, Obstetric anesthesia, Analgesia, Epidural, Postal questionnaire, Epidural catheter, Anesthesiology and Pain Medicine, Spinal needles, Anesthesiology, Anesthesia, Obtaining consent, Surveys and Questionnaires, medicine, Analgesia, Obstetrical, Anesthesia, Obstetrical, business
Abstract

Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research. Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists’ Society residing in Canada. Nonresponders were mailed a second questionnaire three months later. Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles. Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.

Published
2001

22. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

Author

Gordon H. Fick, Theresa Yang, David P. Archer, and Terrance W. Breen

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Analgesic, Indomethacin, Intrathecal morphine, Naproxen, medicine, Humans, Injections, Spinal, Pain Measurement, Chemotherapy, Pain, Postoperative, Elective cesarean section, Morphine, business.industry, Cesarean Section, Anti-Inflammatory Agents, Non-Steroidal, General Medicine, Nalbuphine, Surgery, Analgesics, Opioid, Anesthesiology and Pain Medicine, Anesthesia, Visual analogue scale pain score, Female, Opioid analgesics, business, medicine.drug
Abstract

To test the hypothesis that 0.1 mg intrathecal morphine plus NSAIDs provides satisfactory analgesia post-Cesarean section with fewer side effects than 0.25 mg intrathecal morphine.Sixty women, scheduled for elective Cesarean section under spinal anesthesia, were randomized to receive either 0.1 mg or 0.25 mg intrathecal morphine combined with hyperbaric bupivacaine 0.75% and 20 microg fentanyl. All patients received a 100 mg indomethacin suppository at the end of surgery and 500 mg naproxen p.o. b.i.d. was started the evening of surgery and continued until discharge. A blinded researcher recorded the pain, pruritus, and nausea scores, the time to first request for additional analgesics, a visual analogue scale (VAS) satisfaction score, and the use of additional opioids, antipruritics, and/or antiemetics.Of the 60 patients enrolled, two were not included in the data analysis because of protocol violations leaving 30 patients in the 0.1 mg group and 28 in the 0.25 mg group. There were no differences in the VAS pain scores or the number of women requesting an opioid other than codeine between the two groups. The VAS pruritus scores in the 0.1 mg group were lower throughout the 24 hr (P0.001). Fewer women in the 0.1 mg group (4/30 vs 12/28) requested nalbuphine to treat itching (P = 0.018). Nausea scores were lower in the 0.1 mg group (P0.001).The use of 0.1 mg intrathecal morphine plus NSAIDs provides analgesia of similar quality to 0.25 mg but with fewer undesirable side effects following Cesarean section.

Published
1999

23. Prevalence of coagulation abnormalities associated with intrauterine fetal death

Author

James E. Watkins, Andrew Maslow, Nancy E. Oriol, Mukesh C. Sarna, Anil K. Soni, and Terrance W. Breen

Subjects
Gynecology, medicine.medical_specialty, Fetus, Pregnancy, Obstetrics, business.industry, Platelet Count, Perforation (oil well), Pregnancy Complications, Cardiovascular, General Medicine, Blood Coagulation Disorders, medicine.disease, Anesthesiology and Pain Medicine, In utero, Hypertension, medicine, Coagulopathy, Gestation, Humans, Female, business, Complication, Fetal Death, Placenta Diseases
Abstract

The purpose of this study was to determine factors associated with abnormal coagulation in the setting of intrauterine fetal death (IUFD).We reviewed the charts of 238 patients diagnosed with IUFD over ten years. Data included demographics, co-existing obstetric disease and coagulation studies. A coagulation score was assigned based on the platelet count, prothrombin time, activated partial thromboplastin time and plasma fibrinogen concentration. Approximately 90% of the study population had coagulation scores4. A score ofor = 4 was considered abnormal.Complete coagulation analysis was available in 183/238 patients (77%) within 24 hr of delivery. One hundred and sixty-four of these (89.6%) had a coagulation score,4 and 19 had a scoreor = 4 (10.4%). No relationship between the coagulation score and age, parity, gestational age at delivery, and number of days the dead fetus remained in utero was found. A coagulation score= or 4 was associated with the presence of a pregnancy-related disease (P0.05), notably abruption (P0.001) and uterine perforation (P0.05). Four patients without co-existing disease (3.2%), had a coagulation scoreor = 4.In most pregnancies complicated by fetal demise, the fetus and placenta are delivered within one week of fetal demise. The previously reported severe coagulation disturbances are largely eliminated by early delivery. Our study shows that coagulation abnormalities occur in some patients with uncomplicated IUFDs (3.2%) and that this number rises in the presence of abruption or uterine perforation.

Published
1996

24. Piriformis pyomyositis mimicking epidural abscess in a parturient

Author

Anna M. Kinahan, M. Joanne Douglas, Kari G. Smedstad, and Terrance W. Breen

Subjects
Adult, Anesthesia, Epidural, Epidural Space, medicine.medical_specialty, Pyomyositis, Epidural abscess, Sciatica, Pregnancy, medicine, Anesthesia, Obstetrical, Humans, Abscess, Muscle, Skeletal, Pelvis, Suppuration, medicine.diagnostic_test, Myositis, business.industry, Magnetic resonance imaging, General Medicine, Puerperal Disorders, medicine.disease, Epidural space, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Female, Spinal Diseases, Sciatic nerve, medicine.symptom, business
Abstract

A case is presented of a patient who developed fever, leukocytosis, severe back pain, local overlying spinal tenderness, and left leg weakness on the fifth day postpartum. The patient had epidural anaesthesia for ten hours duration, before and during a forceps delivery. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) of the pelvis and lumbar spine revealed swelling of the left iliacus and piriformis muscles, but no epidural abscess. A diagnosis of isolated piriformis pyomyositis with secondary sciatic nerve irritation was made, and the patient was treated with intravenous antibiotics, non-steroidal anti-inflammatory agents, and morphine analgesia. She made a full, uneventful recovery within 50 days, and was discharged requiring no medications.

Published
1995

25. Epidural anesthesia for labor in an ambulatory patient

Author

Terrance W. Breen, Nancy E. Oriol, Diane Foster-Payne, Bonnell Glass, and Todd Shapiro

Subjects
Adult, medicine.medical_specialty, Adolescent, Epinephrine, Analgesic, Fentanyl, Orthostatic vital signs, Bolus (medicine), Double-Blind Method, Pregnancy, Ambulatory Care, Medicine, Humans, Prospective Studies, Prospective cohort study, Bupivacaine, Labor, Obstetric, business.industry, Surgery, Analgesia, Epidural, Anesthesiology and Pain Medicine, Anesthesia, Ambulatory, Analgesia, Obstetrical, Female, business, medicine.drug
Abstract

The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.

Published
1993

26. Epidural fentanyl and caesarean section: when should fentanyl be given?

Author

James A. Janzen and Terrance W. Breen

Subjects
Adult, Anesthesia, Epidural, medicine.medical_specialty, Lidocaine, Nausea, medicine.drug_class, Sedation, medicine.medical_treatment, Pain, Fentanyl, Double-Blind Method, Pregnancy, Anesthesiology, medicine, Anesthesia, Obstetrical, Humans, Caesarean section, Prospective Studies, Intraoperative Complications, business.industry, Local anesthetic, Cesarean Section, Pregnancy Outcome, General Medicine, Hydrogen-Ion Concentration, Fetal Blood, Surgery, Anesthesiology and Pain Medicine, Treatment Outcome, Anesthesia, Apgar Score, Apgar score, Female, medicine.symptom, business, medicine.drug
Abstract

Epidural fentanyl is often added to epidural local anaesthetic agents to improve the quality of anaesthesia obtained during Caesarean section. Fentanyl may be given either before or after delivery of the infant. When given before delivery, fentanyl has not been reported to cause neonatal depression, although this remains a concern. A prospective, randomized, double-blind study was undertaken to determine if fentanyl was more effective if given before or after delivery of the baby in 64 women undergoing Caesarean section under lidocaine epidural anaesthesia. Maternal outcome was determined by time to achieve T4 neural blockade, the dose of lidocaine necessary to achieve this block and intraoperative scores for pain, nausea, vomiting, shivering, and sedation. Neonates were assessed by umbilical arterial blood pH and Apgar scores. No differences were detected in either group with respect to maternal or neonatal outcome. We recommend using only epidural local anaesthetic agents before delivery, and giving epidural fentanyl following delivery of the infant.

Published
1992

27. Continuous suprascapular nerve block for analgesia of scapular fracture

Author

John D. Haigh and Terrance W. Breen

Subjects
musculoskeletal diseases, Male, medicine.medical_specialty, Supine position, Catheterization, Scapular fracture, Fractures, Bone, Scapula, medicine, Humans, Local anesthesia, business.industry, Lidocaine, Nerve Block, General Medicine, Suprascapular nerve, Middle Aged, musculoskeletal system, medicine.disease, Bupivacaine, Surgery, Epidural catheter, Catheter, Anesthesiology and Pain Medicine, Suprascapular nerve block, Anesthesia, Analgesia, business
Abstract

Fracture of the scapular is uncommon but painful. A case is described in which a comminuted scapular fracture was treated with a continuous suprascapular nerve block. With the patient lying supine an epidural needle was directed towards the scapular notch via a superior approach and an epidural catheter was placed when the notch was believed to have been identified. Repeat injections of 10 ml bupivacaine 0.25 per cent with 1/200,000 epinephrine provided analgesia within minutes and a duration of 8-10 hr. Injection of 10 ml radio-opaque dye demonstrated the catheter to be lateral to the scapular notch. However, dye dispersed throughout the supraspinous fossa including the scapular notch thus blocking the suprascapular nerve. This case demonstrates that continuous suprascapular nerve block can be performed for five days and that location of the scapular notch is less important than previously thought.

Published
1990

29. Aortocaval compression

Author

Terrance W. Breen

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Internal medicine, medicine, Cardiology, General Medicine, business, Aortocaval compression
Published
1994
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30. The Use of an Anesthesia Information Management System (AIMS) and Secure Internet Access in a Departmental Quality Improvement (QI) Program

Author

Patricia Tucker, Iain C. Sanderson, William C. Gilbert, Terrance W. Breen, and Jorge Valles

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, business.product_category, Quality management, Anesthesia information management system, business.industry, Alternative medicine, medicine, Internet access, Operations management, business
Published
2002
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31. Room I, 10/17/2000 9: 00 AM - 11: 00 AM (PS) Total Spinal Anesthesia Requiring Tracheal Intubation in Parturients: The Association with Failed Epidural Anesthesia

Author

Scott E. Helsley, Terrance W. Breen, Donald H. Penning, and Elizabeth Bell

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, Total spinal, Failed epidural anesthesia, business.industry, medicine.medical_treatment, Anesthesia, Tracheal intubation, medicine, business, Surgery
Published
2000
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37. Maternal Intrapartum Fever and Neonatal Sepsis

Author

Holly A. Muir, David Campbell, Stephen H. Halpern, Wade Blanchard, and Terrance W. Breen

Subjects
Anesthesiology and Pain Medicine, Neonatal sepsis, business.industry, Anesthesia, Medicine, Labor analgesia, business, medicine.disease, Intrapartum Fever
Published
1999
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38. Epidural Analgesia and Back Pain Following Delivery

Author

Wade Blanchard, Stephen H. Halpern, Terrance W. Breen, David Campbell, and Holly A. Muir

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Back pain, medicine, Physical therapy, Prospective randomized study, medicine.symptom, business
Published
1999
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39. Natural History of Postpartum Back Pain and Its Relationship with Epidural Anesthesia

Author

Bernard J. Ransil, Terrance W. Breen, Nancy E. Oriol, and P. A. Groves

Subjects
Natural history, medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Anesthesiology, Anesthesia, medicine, Back pain, medicine.symptom, business
Abstract

Natural History of Postpartum Back Pain and Its Relationship with Epidural Anesthesia P. Groves;T. Breen;B. Ransil;N. Oriol; Anesthesiology

Published
1994
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40. Reply

Author

Terrance W. Breen and James A. Janzen

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1993
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