title: Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient.
abstract: BACKGROUND
  Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™) analgesia as bridging analgesia for epidural placement.
  
  
  METHODS
  Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction) cycle, pain, Richmond Agitation Sedation Scale (RASS), nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded.
  
  
  RESULTS
  The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001), and continued to decrease significantly over the study period (P < 0.0001). The RASS scores continuously improved after each cycle (P < 0.0001). Only 1 parturient from the cohort became lightly sedated (RASS = -1). Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment.
  
  
  CONCLUSIONS
  Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.
authors.affiliation: Department of Anesthesiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Jamil S
authors.initials: JS
authors.lastname: Anwari
authors.affiliation: Department of Anesthesiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Laith
authors.initials: L
authors.lastname: Khalil
authors.affiliation: Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA ; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdullah S
authors.initials: AS
authors.lastname: Terkawi
keywords: Epidural analgesia; labor pain; methoxyflurane inhalation