{
    "abstract": "To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour.\nMEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence.\nThe literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intrathecally usually provides a 4-hour window of acceptable analgesia for patients without complications not anticipating protracted labour. The evolution in dosing of ITN warrants a re-examination of its usefulness in modern obstetric practice.\nPhysicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.\nExaminer l\u2019innocuit\u00e9 et l\u2019efficacit\u00e9 d\u2019une dose unique d\u2019analg\u00e9sie rachidienne (injection intrath\u00e9cale de narcotiques [ITN]) durant le travail.\nOn a consult\u00e9 MEDLINE et les bibliographies de 2 revues syst\u00e9matiques et d\u2019une m\u00e9ta-analyse, \u00e0 la recherche d\u2019articles sur l\u2019analg\u00e9sie obst\u00e9tricale et sur la mesure de la douleur. Les 33 articles retenus comprenaient 14 \u00e9tudes, une m\u00e9ta-analyse et 2 revues syst\u00e9matiques, toutes bas\u00e9es sur des preuves de niveau I.\nLa litt\u00e9rature montre que l\u2019ITN repr\u00e9sente une alternatives\u00e9curitaire et efficace \u00e0 l\u2019anesth\u00e9sie \u00e9pidurale. La r\u00e9cente diminution du recours \u00e0 l\u2019\u00e9pisiotomie et aux forceps durant l\u2019accouchement signifie que les patientes requi\u00e8rent moinsd\u2019anesth\u00e9sie p\u00e9rin\u00e9ale. L\u2019avantage de l\u2019ITN en dose unique est que son administration requiert moins de m\u00e9decins et d\u2019infirmi\u00e8res, tout en \u00e9tant aussi s\u00e9curitaire et efficace que les autres analg\u00e9siques. Avec l\u2019ITN, le premier stade du travail est plus court et la dilatation cervicale plus rapide. Une combinaison de 2,5mg de bupivaca\u00efne, de 25 \u03bcg de fentanyl et de 250 \u03bcg de morphine intrath\u00e9caux procure habituellement une analg\u00e9sie suffisante pendant 4 heures chez les patientes sans complications pour lesquelles on ne pr\u00e9voit pas de travail prolong\u00e9. Il faudra r\u00e9\u00e9valuer l\u2019utilit\u00e9 des doses d\u2019ITN utilis\u00e9es dans le cadre de la pratique obst\u00e9tricale moderne.\nLes m\u00e9decins qui pratiquent une obst\u00e9trique moderne dans les petits centres urbains ou en milieu rural pourraient trouver que l\u2019ITN en dose unique est une alternative int\u00e9ressante \u00e0 l\u2019analg\u00e9sie parent\u00e9rale ou \u00e9pidurale pour certaines patientes.",
    "authors": [
        {
            "affiliation": "Northern Ontario School of Medicine, Sioux Lookout. rminty@gosiouxlookout.com",
            "firstname": "R G",
            "initials": "RG",
            "lastname": "Minty"
        },
        {
            "affiliation": null,
            "firstname": "Len",
            "initials": "L",
            "lastname": "Kelly"
        },
        {
            "affiliation": null,
            "firstname": "Alana",
            "initials": "A",
            "lastname": "Minty"
        },
        {
            "affiliation": null,
            "firstname": "D C",
            "initials": "DC",
            "lastname": "Hammett"
        }
    ],
    "conclusions": "Physicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.\nLes m\u00e9decins qui pratiquent une obst\u00e9trique moderne dans les petits centres urbains ou en milieu rural pourraient trouver que l\u2019ITN en dose unique est une alternative int\u00e9ressante \u00e0 l\u2019analg\u00e9sie parent\u00e9rale ou \u00e9pidurale pour certaines patientes.",
    "copyrights": null,
    "doi": null,
    "journal": "Canadian family physician Medecin de famille canadien",
    "keywords": [],
    "methods": null,
    "publication_date": "2007-09-18",
    "pubmed_id": "17872679\n8405628\n0\n7008655\n7970472\n2742176\n7659207\n8010467\n9141940\n12011873\n12818975\n9187779\n7618720\n3692728\n8250306\n10839903\n15731325\n9466102\n15716559\n12011872\n10796196\n11799501\n12160502\n6548639\n11950182\n17013227\n11226098\n9952167\n2008953",
    "results": null,
    "title": "Single-dose intrathecal analgesia to control labour pain: is it a useful alternative to epidural analgesia?",
    "xml": "<Element 'PubmedArticle' at 0x7885037e6ca0>"
}