Doğum eylemindeki gebelerde intravenöz parasetamol kullanımının analjezik etkinliği; prospektif, randomize kontrollü çalışma.

Year 2019, , 1303 - 1316, 15.04.2019

Gerçek Aydın Mehpare Tüfekçi Mehmet Bülbül , Ahmet Yılmaz Kemal Özerkan

https://doi.org/10.30569/adiyamansaglik.501585

Abstract

Amaç: Doğum ağrısı kadının yaşamı
boyunca karşılaşacağı en şiddetli ağrılardan biridir. Doğum eylemi
analjezisinde günümüzde en etkili yöntem epidural analjezidir (EA). Fakat her
zaman ulaşılabilir değildir. Bundan dolayı farklı alternatifler düşünülmüştür.
Biz de intravenöz parasetamolu (IVP) bu amaçla kullanmayı araştırdık.

Yöntem:
Eylül 2007-Ağustos
2008 tarihleri arasında prospektif, plasebo kontrollü olarak iki merkezli
olarak planlandı. Randomizasyon sonrası IVP grubunda 32,  epidural analjezi grubunda 24 ve plasebo
grubunda 37 gebe olmak üzere 93 kişi çalışmaya dahil edildi.

Bulgular: Plasebo grubunda, hem IVP hem de
EA grubuna göre daha yüksek 1. dk APGAR skorları elde edilmiştir. Fakat 5. dk
APGAR skorları bakımından üç grup arasında fark saptanamamıştır. VAS
ortalamaları bakımından üç grup karşılaştırıldığında en düşük ortalama EA
grubunda en yüksek ortalama plasebo grubunda saptandı. VAS ortalamaları IVP
grubunda 7,7–8,5 aralığında, EA grubunda 4–6 aralığında ve plasebo grubunda ise
8–9,5 aralığında olduğu saptandı. IVP ve Plasebo gruplarında doğum eylemi
ilerlediğinde VAS skorları artarken EA grubunda azaldı. Epidural analjezi
grubunda daha belirgin olmak üzere parasetamol grubunda da, 0 ile 30.
dakikalardaki VAS skorları farkı negatif değerler olarak saptanmış ve 30. dk
skorlarının daha düşük olduğu görülmüştür. Epidural analjezi grubunda 0 ile 60.
dk skorları farkı da negatif değer olarak saptanmışken diğer iki grupta bu fark
saptanmamıştır. Genel olarak tüm gruplar için eylemin erken evrelerinde ağrı
daha yaygın alanda tarif edilmişken, eylem ilerledikçe ağrının daha iyi
lokalize edildiği görülmektedir.

Sonuç: EA’nin uygulanamadığı durumlarda IVP güvenli ve kolay
uygulanabilir bir seçenek olarak göz önünde bulundurulabilir. IVP’ün tek başına
ya da kombinasyon tedavilerinde daha sık ya da farklı dozlar kullanılarak
etkinliğinin değerlendirileceği, iyi standardize edilmiş geniş katılımlı klinik
çalışmalara ihtiyaç duyulmaktadır.

Keywords

Ağrı, Analjezi, Doğum eylemi, Epidural analjezi, parasetamol

The efficacy of intravenous paracetamol as an analgesic for women during labor pain: a prospective, randomized controlled trial

Abstract

Objective: Labor pain is one of
most severe pain that women may suffer during a lifetime. Actually, epidural
analgesia (EA) is the most effective method for labor pain. But it is not available
every time and alternative approaches needed. We observed intravenous
paracetamol (IVP) for this purpose.

Methods: Our study was planned
as a prospective, randomized controlled trial in two centers, during September
2007 - August 2008. After randomization, 32 patients were included in IVP
group, 24 patients in EA group and 37 patients in placebo groups that total
number was 93.

Findings: Highest 1st minute
APGAR scores were detected in placebo group, compared to IVP and EA groups.
But, for 5th minute APGAR scores, no difference was detected among three
groups. Lowest VAS scores obtained in EA group whereas highest scored were in
Placebo group. Mean VAS scores were 8-9.5 for placebo, 7.7-8.5 for IVP and 4-6
for EA groups. As labor progresses, VAS scores were increasing in IVP and
placebo groups whereas for EA group scores decreased. When 0 and 30 minutes VAS
scored considered, both EA and IVP groups showed lower 30 minutes scores, where
the difference was more prominent for EA group. This effect was still detected
in EA group but not in other two groups in 60 minutes scores. For all groups,
pain was described as diffuse pain in early stages of labor, but better
localized as labor progresses.

Conclusion: For labor pain, IVP can
be considered as a safe and easily applicable option when EA is not available.
Well standardized studies including more participants, observing IVP alone or
in a combination treatment for labor pain with more frequent and higher
dosages, are needed.

Keywords

Analgesia, Epidural analgesia, Labor, Pain, Paracetamol

References

• 1. Gupta A, Daigle S, Mojica J, Hurley RW. Patient perception of pain care in hospitals in the United States. J Pain Res 2009;2:157–164.
• 2. Obstetric analgesia and anesthesia. ACOG Practice Bulletin No. 36. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;100:177–191.
• 3. Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. Natl Vital Stat Rep 2011;59(5):1–13, 16.
• 4. OfirmevTM (acetaminophen) injection prescribing information Cadence Pharmaceuticals, Inc.
• 5. Singla NK, Parulan C, Samson R, et al. Plasma and cerebrospinal fluid pharmacokinetic parameters after single-dose administration of intravenous, oral, or rectal acetaminophen. Pain Pract 2012;12(7):523–532.
• 6. Kane RL, Bershadsky B, Rockwood T, Saleh K, Islam NC. Visual Analog Scale pain reporting was standardized. J Clin Epidemiol 2005;58:618-23.
• 7. Prescott LF. Paracetamol (Acetaminophen) a Critical Bibliographic Review. London: Taylor & Francis; 1996. 33–59.
• 8. Pfaffenrath V, Rehm M. Migraine in pregnancy: what are the safest treatment options? Drug Saf 1998;19:383–8.
• 9. Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryngol 2008;265:351–5.
• 10. Ankumah NE, Tsao M, Hutchinson M, Pedroza C, Mehta J, Sibai BM, Chauhan SP, Blackwell SC, Refuerzo JS. Intravenous Acetaminophen versus Morphine for Analgesia in Labor: A Randomized Trial. Am J Perinatol. 2017 Jan;34(1):38-43. doi: 10.1055/s-0036-1584143.
• 11. Olayemi O, Aimakhu CO, Akinyemi OA. The influence of westernisation on pain perception in labour among parturients at the university college hospital Ibadan. J Obstet Gynaecol. 2006;26:329–31.
• 12. Onah HE, Obi SN, Oguanuo TC, Ezike HA, Ogbuokiri CM, Ezugworie JO. Pain perception among parturients in Enugu, South-eastern Nigeria. J Obstet Gynaecol 2007;27: 585–8.
• 13. Hahn TW, Mogensen T, Lund C, Jacobsen LS, Hjortsoe NC, Rasmussen SN, Rasmussen M. Analgesic effect of i.v. paracetamol: possible ceiling effect of paracetamol in postoperative pain. Acta Anaesthesiol Scand 2003;47:138–45.
• 14. Dailland P, Chaussis P, Landru J, Belkacem H. Epidural anesthesia for labor. Cah Anesthesiol 1996;44:127–43.
• 15. East CE, Colditz PB. Effect of maternal epidural analgesia on fetal intrapartum oxygen saturation. Am J Perinatol 2002;19:119–26.
• 16. Coppejans HC, Hendrickx E, Goossens J, Vercauteren MP. The sitting versus right lateral position during combined spinal–epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg. 2006;102:243–7.
• 17. Fernández–Guisasola J, Delgado Arnáiz C, Rodríguez Caravaca G, Serrano Rodríguez ML, García del Valle S, Gómez–Arnau JI. Epidural obstetric analgesia, maternal fever and neonatal wellness parameters. Rev Esp Anestesiol Reanim 2005;52:217–21.
• 18. Zhang J, Klebanoff MA, DerSimonian R.Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Am J Obstet Gynecol 1999;180: 970–7.
• 19. Ros A, Felberbaum R, Jahnke I, Diedrich K, Schmucker P, Hüppe M. Epidural anaesthesia for labour: does it influence the mode of delivery? Arch Gynecol Obstet 2007;275:269–74.
• 20. Bakhamees H, Hegazy E. Does epidural increase the incidence of cesarean delivery or instrumental labor in Saudi populations? Middle East J Anesthesiol 2007;19:693–704.
• 21. Decca L, Daldoss C, Fratelli N, Lojacono A, Slompo M, Stegher C, Valcamonico A, Frusca T. Labor course and delivery in epidural analgesia: a case–control study. J Matern Fetal Neonatal Med 2004;16:115–8.
• 22. Leighton BL, Halpern SH. Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Semin Perinatol 2002;26:122–35.
• 23. Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta–analysis comparing epidural with systemic opioid analgesia. BJOG 2002;109:1344–53.
• 24. Cutura N, Soldo V, Curković A, Tomović B, Mitrović T. Effects of epidural anesthesia on I and II delivery stage and on a newborn. Vojnosanit Pregl. 2009;66:319–22.
• 25. Tugrul S, Oral O, Bakacak M, Uslu H, Pekin O. Effects of epidural analgesia using ropivacaine on the mother and the newborn during labor. Saudi Med J 2006;27:1853–8.
• 26. Parker RK, Connelly NR, Lucas T, Serban S, Pristas R, Berman E, Gibson C. Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects. J Anesth 2007;21:142–7.
• 27. Caracostea G, Stamatian F, Lerintiu M, Herghea D. The influence of maternal epidural analgesia upon intrapartum fetal oxygenation. J Matern Fetal Neonatal Med 2007;20:161–5.
• 28. O'Connell MP, Hussain J, Maclennan FA, Lindow SW. Factors associated with a prolonged second state of labour–a case–controlled study of 364 nulliparous labours. J Obstet Gynaecol 2003;23:255–7.
• 29. Schiessl B, Janni W, Jundt K, Rammel G, Peschers U, Kainer F. Obstetrical parameters influencing the duration of the second stage of labor. Eur J Obstet Gynecol Reprod Biol 2005;118:17–20.
• 30. Klostergaard KM, Terp MR, Poulsen C, Agger AO, Rasmussen KL. Experience of pain in relation to birth weight in primiparae. Ugeskr Laeger 2002;164:1214–7.
• 31. Klostergaard KM, Terp MR, Poulsen C, Agger AO, Rasmussen KL. Labor pain in relation to fetal weight in primiparae. Eur J Obstet Gynecol Reprod Biol 2001;99:195–8.
• 32. Weil K, Hooper L, Afzal Z, Esposito M, Worthington HV, van Wijk AJ, Coulthard P. Paracetamol for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev 2007;18:CD004487.
• 33. Agrawal S, Fitzsimons JJ, Horn V, Petros A. Intravenous paracetamol for postoperative analgesia in a 4–day–old term neonate. Paediatr Anaesth 2007;17:70–1.
• 34. Neymark MI, Kovalev AI. Analgesia of labor in women with diabetes mellitus. Anesteziol Reanimatol. 2015 Jan-Feb;60(1):16-8.
• 35. Abd-El-Maeboud KH, Elbohoty AE, Mohammed WE, Elgamel HM, Ali WA. Intravenous infusion of paracetamol for intrapartum analgesia. J Obstet Gynaecol Res 2014;40(11):2152–2157.
• 36. Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain management in labour. Cochrane Database of Systematic Reviews 2010;9:CD007396. Doi: 10.1002/14651858.CD007396.pub2
• 37. Jones L, Othman M, Dowswell T, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev 2012;3:CD009234. Doi: 10.1002/14651858. CD009234.pub2
• 38. Alhashemi JA, Alotaibi QA, MashaatMS, Kaid TM, Mujallid RH, Kaki AM. Intravenous acetaminophen vs oral ibuprofen in combination with morphine PCIA after Cesarean delivery. Can J Anaesth 2006;53(12):1200–1206.
• 39. Candiotti KA, Bergese SD, Viscusi ER, Singla SK, Royal MA, Singla NK. Safety of multiple-dose intravenous acetaminophen in adult inpatients. Pain Med 2010;11(12):1841–1848.
• 40. Jokela R, Ahonen J, Seitsonen E, Marjakangas P, Korttila K. The influence of ondansetron on the analgesic effect of acetaminophen after laparoscopic hysterectomy. Clin Pharmacol Ther 2010;87;(6):672–678
• 41. Wininger SJ, Miller H, Minkowitz HS, et al. A randomized, doubleblind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clin Ther 2010;32;(14):2348–2369.