DOĞUMUN İKİNCİ EVRESİNDE EPİDURAL ANALJEZİDE BUPİVAKAİN İLE BUPİVAKAİN +FENTANİL KOMBİNASYONUNUN KARŞILAŞTIRILMASI

Yıl 2019, Cilt: 52 Sayı: 2, 123 - 127, 31.07.2019

Meltem Bektaş Alp Alptekin Bülent Baltacı Türkay Çakan Nurten Ünal

Öz

ÖZET

Amaç: Doğumun
2. evresinde epidural yolla uygulanan düşük konsantrasyondaki bupivakain +
fentanil ile daha yüksek konsantrasyondaki bupivakaini, analjezi kalitesi, bu
evrenin süresi ve seyri, çıkımda enstrümantasyon gereksinimi, hemodinamik
parametreler ile maternal ve neonatal yan etkiler bakımından karşılaştırmayı
amaçladık.

Gereç ve Yöntem: Doğum eylemi başlamış ve ağrı kontrolü isteyen 40 gebe rastgele 2 gruba
ayrıldı.  Epidural kateterizasyonu
takiben doğumun 1. evresinde her 2 gruba da 3cc %0.5 bupivakain +50mcg fentanil
+8cc %0.9’luk NaCl verildi. Doğumun 2. evresinde ise 1.gruba (n=20)4cc %0,5bupivakain
+ 4cc %0.9’luk NaCl,2.grub (n=20)ise 2cc %0.5bupivakain+ =.67 cc
fentanil(33.5mcg)+5.33cc%0.9’luk NaCl verildi. Çalışma süresince maternal
sistolodiastolik kan basınçları, kalp atım hızı ve fötal kalp atım hızları
izlendi. Ağrı ve aneljezinin etkinliği VAS ve iğne batırma yöntemleri ile
değerlendirildi, maternal ve neonatal yan etkiler kaydedildi.

Bulgular:
Birinci grupta aneljezi başlama süresi anlamlı olarak uzun (p<0.001), toplam
analjezi süresi ise anlamlı olarak kısa bulundu(p<0.001). İkinci evre
süresi(doğum eylemi)açısından gruplar arası fark bulunmadı (p>0.05). Doğumun
2. evresindeki epizyotomi tamiri için ek analjezik gereksinimi, 1.grupta 2.
gruba göre anlamlı olarak daha fazla bulundu.(p<0.001).

Sonuç: Doğumun
2.evresinde doğum ağrısını gidermede her iki uygulama yöntemi de yararlı
olmakla birlikte fentanil ilave edilen grupta daha iyi sonuçlar elde
edilmiştir.

 

 

Anahtar Kelimeler: Epidural analjezi, doğum, bupivakain,
fentanil

 

SUMMARY

 

Purpose: We aimed to compare analgesic
quality, progress and time of second stage labor, need to instrumental
delivery, hemodynamic parameters, maternal and fetal side effects of lower
concentration  bupivacain+fentanyl and
higher concentration bupivacaine used in second stage labor from epidural
route.

Materials and Method: Forty pregnant women in labor and
demanding pain relief were divided into 2 randomized groups. Following epidural
catheterisation,patients in both groups were given 3cc of 0.5% bupivacaine
+50mcg fentanyl+8cc  of 0.9 %Nacl in the
first stage labor. In the second stage labor, 4cc of 0.55 bupivacaine +4cc of
0.9 % NaCl were given to the first group of patients (n=20), while the second
group had 2cc of 0.5% bupivacaine +0.67 cc fentanyl (33.5mcg)+5.33 cc of 0.9 %
NaCl. .During the study maternal systolodiastolic blood pressures, heart rates
and fetal heart rates were monitored. Pain and effectiveness of analgesia were
evaluated by VAS and pin prick test and maternal and neonatal side effects were
recorded.

Results: İn the first group, duration to
the  onset  of 
analgesia was significantly (p<0.001)shorter. For the second stage of
labor there was  no significantly
(p<0.001) longer, while total analgesia 
time was significantly (p<0.001)shorter. For the second stage of
labor there was no significant 
difference (p>0.05) between the groups . Supplementary analgesic need
for episiotomy repair in the second stage was significantly higher in the first
group (p<0.001).

Conclusion: Althought both methods were
effective in relieving pain of the second stage of labor, the fentanyl added
group had better results.

 

 

Keywords: Epidural analgesia, labor,
bupivacaine, fentanyl

Anahtar Kelimeler

Epidural analjezi, doğum, bupivakain

Kaynakça

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