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Background and Aims Single-shot neuraxial techniques are not useful for most labor analgesia. Intravenous patient-controlled analgesia (iv-PCA) is indicated for parturients who cannot receive neuraxial analgesia. We present two cases managed with a combined single-shot technique and iv-PCA.
Methods Case 1: A 37-year-old, G1P0 woman presented at 19 weeks gestation for abortion indicated with fetal abnormalities. She had a medical history of thoracic to lumber spine surgery for scoliosis. We determined continuous epidural analgesia was not possible and choose a combination of single- shot spinal anesthesia combined with iv-PCA. Before cervical dilatation procedures, 200 mcg of morphine with 7.5mg of bupivacaine was administered intrathecally using a 25-gauge needle. Following induction with prostaglandin E2, iv-PCA with fentanyl (10 mcg/h, 25 mcg/bolus, lockout time 10 min) was initiated. Standard monitors were placed, and the respiratory monitored with ETCO2 continuously until 24 hours after administration. The low dose of naloxone was administered to manage opioid side effects such as pruritus or nausea. Pain control during labor was adequate and the parturient was delivered without serious complications. Case 2: A 27-year-old, G5P0 presented at 21 weeks gestation for abortion indicated with a fetal abnormality. She was not eligible for epidural analgesia due to anticoagulant therapy. 200 mcg of morphine with 10mg of bupivacaine was administered and then the same protocols were used in this parturients. Pain control during labor was good and opioid side effects were well controlled with naloxone.
Conclusions A single-dose technique combined with iv-PCA provided adequate labor analgesia in mid-term delivery without serious complications.
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