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In this 240th episode I welcome Drs. Hofkamp and Sharpe to the show to discuss their work investigating whether there may be inadequate analgesia for patients undergoing cesarean delivery.
CME: Link
Dr. Sharpe is on Twitter @emilysharpe
Dr. Hofkamp is on Twitter @hofkampmichael
Random Recs:
Euphoria: Link
Phil Mickelson Biography: Link
What Happend To You: Link
Dear Jed et all.
Thank you for an interesting episode. I found the rates of pain (10%? 20%?!!) during Caesarean section quoted staggering.
I do regular obstetrics as a consultant (attending) in the UK. In my last 115 sections under regional, I’ve had three cases of women requiring additional analgesia (so a rate of 2.6%). Of course it’s possible they’re having pain and not telling me, but I check and talk to them throughout the case, and I don’t think that’s the case.
Something that wasn’t discussed on your podcast was the importance of checking the block before the start, as there is a lot of variability in how this is done. I aim for T5 to light touch (first normal dermatome to touch being T4).
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15717 is recommended reading.
Love the podcast, many thanks
Dr. Bishop,
Thank you for supporting the podcast and taking the time to comment! In the Keltz study we cited (https://pubmed.ncbi.nlm.nih.gov/34448323/), anesthesiologists and OB’s were very poor at accurately diagnosing pain during cesarean deliveries. We believe that the evidence suggests that 5-6% of patients will need conversion to GA for inadequate regional anesthesia and 15-20% of patients will require an anesthetic adjuvant agent despite apparently adequate regional anesthesia. The key is to not let hubris get in the way of doing the right thing and going to GA.
Mike