Our New Choice in Labour Analgesia, Combined Spinal-Epidural Analgesia: Our Short Term Results

Year 2020, Volume: 6 Issue: 1, 99 - 105, 30.04.2020

Ahmet Gültekin , Ebru Canakci

https://doi.org/10.19127/mbsjohs.690840

Cited By: 1

Abstract

Objective: Nowadays, the painless childbirth preference of expectant mothers is gradually increasing. The most important and first objective in labor analgesia should be the safety of mother and baby. Our objective in this study is to compare the effects of combined spinal-epidural analgesia (CSE) and epidural analgesia on analgesia quality and labor in labour analgesia.
Methods: Our study was performed prospectively on 40 primigravid pregnant women who requested painless childbirth and were included in the ASAI-II group, between September 1, 2018, and November 30, 2018. Pregnant women who had single fetus at 36-42 weeks, have vertex presentation, no contraindications for regional analgesia, have active contractions and with 3-4 cm cervical opening were randomly divided into two groups in the study. Combined Spino Epidural group (= Group CSE, n = 20), Epidural analgesia group (= Group EPI, n = 20) was determined as the groups. To the pregnant women in the Group CSE, Intrathecal dose in a manner that 2.5 mg hyperbaric bupivacaine + 12.5 µg fentanyl total volume of 1 ml was injected. To the pregnant women in the Group EPI, 20 G epidural catheter was placed with the method used in the first group and fixed to the skin. Epidural analgesia solutions (20 mg bupivacaine + 50 µg fentanyl +15 cc saline) were prepared in 20 cc injectors containing 0.1% bupivacaine + 2.5 µg/ml fentanyl for use in both groups. When the VAS values became 4, these prepared solutions were planned to be given as 10 ml intermittent bolus from these epidural catheters.
Results: The mean values of maternal age, weight, and height, and infant height have not shown any difference according to the groups (p> 0.05). The first VAS median value was obtained as 5 in both groups. However, the VAS values were accumulated in the higher values in the combined spinal-epidural group (p = 0.031). Although the second VRS and VAS median values were lower in the pure epidural, the outlet VRS and VAS values have been obtained lower in the combined spinal-epidural group.
Conclusion: For normal spontaneous vaginal delivery, every mother should be offered labour analgesia options such as CSE analgesia and epidural analgesia. CSE analgesia may be a good alternative to epidural analgesia because of its advantages such as the onset of fast analgesia, shortening the first stage of labour and increasing the comfort of the mother in the outlet.

Keywords

painless childbirth, combined spinal-epidural analgesia, epidural analgesia

References

• Apiliogulları S, Gok F, Kilicaslan A, Aydogan A, Celik JB .Our Experinces in Single-Shot Spinal Block for Labour Analgesia Selcuk Med J 2010;26(2):38-41.
• Beilin Y. Advances in labor analgesia. Mt Sinai J Med 2002;69:38-44.
• Bilgin F. Combined Spinal-Epidural Analgesia in Pain-Free Delivery Turkey Clinics J Surg Med Sci 2007; 3: 34-40.
• Braga AFA, Carvalho VH, Braga FSDS, Pereira RIC. Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block. Rev Bras Anestesiol. 2019 ; 69(1):7-12.
• Erdine S. Obstetric anesthesia and analgesia applications. Regional Anesthesia. Nobel Medical Bookstore,İstanbul 2005,253–70.
• Gary MS, Stephen PH. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology 2001;94: 593-8.
• Glosten B.Anesthesia for obstetrics. Miller RD(ed), In: Anesthesia, Churchill Livingstone, San Francisco. 2000; 2024-68.
• Gunaydin B. Obstetric Pain and Its Management in the Perinatal Period: What do we need to know? In: Kuczkowski KM, Drobnik L (eds). International Textbook of ObstetricAnaesthesia and Perinatal Medicine. Medmedia, Warsaw 2010; 34-9.
• Landau R. Combined spinal-epidural analgesia for labor: breakthrough or unjustified invasion? Semin Perinatol. 2002;26:109-21.
• Olmez G, Dag IH, Ozyilmaz MA, Yalinkaya A. Can Combined Spinal-Epidural Analgesia be an Alternative to Epidural Analgesia Alone in Labour? Turk J Anaesthesiol Reanim 2003; 31: 66-72.
• Poma S, Scudeller L, Verga C, Mirabile G, Gardella B, Broglia F et al. Effects of combined spinal-epidural analgesia on first stage of labor: a cohort study. J Matern Fetal Neonatal Med. 2018:1-7. doi: 10.1080/14767058.2018.1467892. [Epub ahead of print]
• Sezer AO, Gunaydin B. Efficacy of patient controlled epidural analgesia after initiation with epidural or combined spinal epidural analgesia. Int J Obstet Anesth 2007; 16: 226-30.
• Stocks GM, Hallworth SP, Fernando R, England AJ, Columb MO, Lyons G. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology 2001; 94: 593-8.
• Thomson G, Feeley C, Moran VH, Downe S, Oladapo OT. Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review. Reprod Health. 2019 30;16(1):71.
• Wong CA. Advances in labor analgesia. Int J Women’s Health 2009; 1:139-54.
• Wong CA. Epidural and Spinal Analgesia/ Anesthesia for Labor and Delivery. In: Chestnut DH, Polley LS, Tsen LC, Wong CA (eds). Chestnut’s Obstetric Anesthesia Principals and Practice. 4th edition. Philadelphia: Elsevier Mosby 2009; 429-92.