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DOĞUM ANALJEZİSİNDE SÜREKLİ İNFÜZYON VE HASTA KONTROLLÜ ANALJEZİ YÖNTEMİNİN KOMBİNE SPİNAL EPİDURAL İLE EPİDURAL ANALJEZİ TEKNİKLERİNDE KLİNİK ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Year 2007, Volume: 8 Issue: 1, 27 - 33, 01.04.2007

Abstract

Amaç:Çalışmamızda doğum analjezisinde sürekli infüzyon ile hasta kontrollü analjezi yönteminin kombinespinal epidural (KSE) ile epidural (EP) analjezi tekniklerinde klinik etkinliklerini karşılaştırmayı amaçladık.Gereç ve Yöntemler:Etik kurul onayı ile, vajinal doğum yapması planlanan gebelik haftası 36. ile 42. haftalararasında, tek fetus, verteks presentasyonu olan 60 primigravid gebe çalışmaya alındı. Olgular rastgele iki grubaayrıldı (Grup 1: KSE grubu, Grup 2: EP grubu). KSE grubundaki gebelere 2.5 mg hiperbarik bupivakin ile 25 µgfentanil, toplam volüm 1 ml olacak şekilde verildi. Her iki grupta da kullanılmak üzere bupivakain (0.5 mg/ml) ilefentanil (1.5 µg/ml) içeren EP infüzyon solüsyonları hazırlandı. Ağrının derecesi vizüel analog skala (VAS)kullanılarak değerlendirildi. EP grubundaki gebelere hemen, KSE grubundaki gebelere ise intratekal dozunanaljezik etkisinin geçip VAS 4 olduğunda %0.125 bupivakain + 50 µg fentanil 10 ml yükleme dozu ve hemenardından 10 ml/saat bazal hız olacak şekilde EP infüzyon başlandı. İki gruptaki gebelerin ihtiyaç duyduklarında10 ml bolus doz uygulayabilmeleri sağlandı. Maternal ve fetal hemodinamik monitorizasyon yapıldı. Gebelereanaljezi başlangıç dozu verildikten sonra ağrının tamamen kaybolma süresi kaydedildi. Doğumun 1., 2. dönemsüreleri, EPinfüzyon süresi, total EPinfüzyon miktarı, tüketilen bupivakain miktarları, ek bolus doz gereksinimi,travayda ve postpartum dönemde gelişen yan etkiler kaydedildi.Bulgular:KSE grubunda analjezinin başlama süresi EP gruba göre çok kısaydı. KSE grubunda özellikledoğumun 1. evresinde servikal dilatasyonda hızlı artma ve doğumun süresinde kısalma gözlendi. KSE grubundaannenin hemodinamisi daha iyi korunduğu hipotansiyonun olmadığı, infüze edilen lokal anestezi (LA)miktarlarının çok düşük olduğu ve anne memnuniyetinin EPgruba oranla daha fazla olduğu gözlendi.Sonuç:Doğum analjezisinde sürekli infüzyon ile birlikte hasta kontrollü analjezi yönteminde KSE analjezininEPanaljeziye oranla daha güvenilir bir yöntem olduğunu söyleyebiliriz

References

  • 1. Beilin Y. Advances in labor analgesia. Mt Sinai J Med 2002;69:38-44.
  • 2. Shnider SM, Levinson G. Anesthesia for obstetrics. Miller RD (ed), In: Anest-hesia Churchill Livingstone, NewYork, 1994;2031-2076.
  • 3. Erdine S. Doğum ağrısı ve analjezisi. Ağrı 2002;3:136- 143.
  • 4. Glosten B.Anesthesia for obstetrics. Miller RD (ed), In: Anesthesia, Churchill Livingstone, San Francisco. 2000; 2024-2068.
  • 5. Gary MS, Stephen PH. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology 2001; 94: 593- 598.
  • 6. van der Vyver M, Halpern S, Joseph G. Patientcontrolled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis. Br J Anaesth 2002;89:459-465.
  • 7. Chestnut DH. Does earyl administration of epidural analgesia affect obstetrics outcome in nulliparous women who are receiving intravenous oxytocin. Anesthesiology 1994;80:1193-1198.
  • 8. Pirbudak L, Tuncer S, Kocoglu H, Göksu S, Celik C. Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05% in patient-controlled epidural analgesia in labour. Eur JAnaesthesiol 2002;19:271-5.
  • 9. Palmer CM. The dose response relation of intrathecal fentanyl for labor analgesia. Anesthesiology 1998; 88:355-61.
  • 10. Celeski DC. Effect of intrathecal fentanyl dose on the duration of labor analgesia.AANAJ 1999;67:239-44.
  • 11. Stocks GM. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl.Anesthesiology 2001;94:593-8.
  • 12. Palmer CM. Bupivacaine augments intrathecal fentanyl for labor analgesia. Anaesthesiology 1999;91:84-9.
  • 13. Lee BB. Combined spinal epidural analgesia in labor comprasıon of two doses of intrathecal bupivacaine with fentanyl.AnesthAnalg 1999;83:868-71.
  • 14. Harman NI, Choi KC, Afleck PJ. Analgesia, pruritis and ventilation exhibit a dose response relatıonship in parturients receiving intrathecal fentanyl during labor. AnesthAnalg 1999;89:378-83.
  • 15. Collis RE, Plaat FS, Morgan B M. Comprasion of midwife top-ups, continuous infusion and patient controlled epidural analgesia for maintaining mobility after a low-dose combined spinal epidural. Br JAnaesth 1999;82:233-6.
  • 16. Cascio M, Pygon B, Bennett C, Ramanathan S. Labour analgesia with intrathecal fentanyl decreases maternal stress. Can JAnesth 1997;44:605-609.
  • 17. Tsen LC, Thue B, Data S, Segal S. Is combined-spinal epidural analgesia associated with more rapid cervical dilatation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999;91:920-5.
  • 18. Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Eng J Med 1997;337:1715-9.
  • 19. Stoddart AP, Nicholson KEA, Popham PA. Low dose bupivacaine/fentanyl epidural infusions labour and mode of delivery.Anesthesia 1994;49:1087-90.
  • 20. Olofsson C H, Ekblom G, Ekman-Ordeberg G, Irested L. Obstetric outcome following epidural analgesia with bupivacaine-adrenaline 0.25% or bupivacaine 0.125% with sufentanil. A prospective randomized controlled study in 1000 parturients. Acta Anaest Scand 1998;42:284-92.
  • 21. Hughes D, Simmons SW, Brown J, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2003;(4):CD003401.
  • 22. Bren TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in ambulatory patient,AnaesthAnalg 1993;77:919-924.
  • 23. Kuczkowski KM. Ambulation with combined spinalepidural labor analgesia: the technique. Acta Anaesthesiol Belg. 2004;55:29-34.
  • 24. Stacey RG, Watt S, Kadim MY, Morgan BM. Single space combined spinal-extradural technique for analgesia for labour. Br JAnaesth 1993;71:499-502.
  • 25. Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural analgesia, Technique, management, and outcome of 300 mothers. Int J ObstAnest 1994;3:75-81.
  • 26. Sheila EC, Julie Y, Edward TR, Tracey MV. Walking with labor epidural analgesia. Anesthesiology 2000;92:387-92.
  • 27. Capogna G, Camorci M. Epidural analgesia for childbirth: effects of newer techniques on neonatal outcome. Paediatr Drugs 2004;6:375-86.
  • 28. Uysalel A. Epidural analjezinin doğumun ilerlemesi veyeni doğan üzerine etkileri. TARK 2001özet kitabı 297-302.
  • 29. Clarke VT, Similey RM, Finster M. Uterin hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia? (letter).Anesthesiology 1994; 81:1083-1087.
  • 30. Sia AT, Camann WR, Ocampo CE, Goy RW, Tan HM, Rajammal S. Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour. Can JAnaesth 2004;51:581-5.

Comparison of Clinical Efficacies of Combined Spinal -Epidural versus Epidural Analgesia Techniques Performed with the Continuous Patient Controlled Infusion Method in Labor Analgesia

Year 2007, Volume: 8 Issue: 1, 27 - 33, 01.04.2007

Abstract

Objective: Our aim was to compare the clinical efficacies of combined spinal-epidural analgesia and epidural analgesia techniques performed with the continuous patient controlled infusion method in labor analgesia. Material and Methods: Following approval of the local ethics committee, 60 primigravid singleton pregnant women between 36 and 42 weeks of pregnancy, with vertex presentation and planned to give vaginal birth were included in the study. Patients were randomly divided into two groups. (Group 1: Combined spinal epidural analgesia (CSE) group and Group 2: Epidural analgesia (EP) group). Participants in CSE group were given a total volume of 1 ml, which is composed of 2.5 mg hyperbaric bupivacain and 25 µg fentanyl. EP infusion solutions were prepared with bupivacaine (0.5 mg/ml) and fentanyl (1.5µg/ml) for use in both groups. The degree of pain was assessed by using visual analogue scale (VAS).A10 ml loading dose consisting of 0.125% bupivacaine and 50 µg fentanyl was applied in the EP group. The CSE group received this dose when the VAS score reached 4 after the disapearance of the effect of intrathecal dose. EP infusions with a basal flow rate of 10ml/hr were given immediately after bolus doses. The pregnant women in both groups were able to apply themselves a bolus dose of 10 ml when needed. Maternal and fetal hemodynamic parameters were monitored. The period of time from the first application of analgesia until total dissappearance of the pain was recorded in all subjects. The durations of the first and second stages of labor, durations of EP infusions, total amounts of EP infusions, consumed bupivacaine amounts, any need for further bolus doses, adverse effects in the intrapartum and postpartum periods were recorded. Results: Initiation time of analgesia in subjects of CSE group was much shorter than the EP group. Especially, more rapid dilatation of cervix in the first stage of labor and a shorter labor time were observed in CSE group. Better preserved maternal hemodynamics without hypotension, lower amounts of infused local anesthetics and better patient satisfaction were also observed in theCSEgroup compared with the EPgroup. Conclusion: We can comment that CSE analgesia technique performed with continuous patient controlled infusion method is a more reliable method than EPanalgesia technique in labor analgesia.

References

  • 1. Beilin Y. Advances in labor analgesia. Mt Sinai J Med 2002;69:38-44.
  • 2. Shnider SM, Levinson G. Anesthesia for obstetrics. Miller RD (ed), In: Anest-hesia Churchill Livingstone, NewYork, 1994;2031-2076.
  • 3. Erdine S. Doğum ağrısı ve analjezisi. Ağrı 2002;3:136- 143.
  • 4. Glosten B.Anesthesia for obstetrics. Miller RD (ed), In: Anesthesia, Churchill Livingstone, San Francisco. 2000; 2024-2068.
  • 5. Gary MS, Stephen PH. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology 2001; 94: 593- 598.
  • 6. van der Vyver M, Halpern S, Joseph G. Patientcontrolled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis. Br J Anaesth 2002;89:459-465.
  • 7. Chestnut DH. Does earyl administration of epidural analgesia affect obstetrics outcome in nulliparous women who are receiving intravenous oxytocin. Anesthesiology 1994;80:1193-1198.
  • 8. Pirbudak L, Tuncer S, Kocoglu H, Göksu S, Celik C. Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05% in patient-controlled epidural analgesia in labour. Eur JAnaesthesiol 2002;19:271-5.
  • 9. Palmer CM. The dose response relation of intrathecal fentanyl for labor analgesia. Anesthesiology 1998; 88:355-61.
  • 10. Celeski DC. Effect of intrathecal fentanyl dose on the duration of labor analgesia.AANAJ 1999;67:239-44.
  • 11. Stocks GM. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl.Anesthesiology 2001;94:593-8.
  • 12. Palmer CM. Bupivacaine augments intrathecal fentanyl for labor analgesia. Anaesthesiology 1999;91:84-9.
  • 13. Lee BB. Combined spinal epidural analgesia in labor comprasıon of two doses of intrathecal bupivacaine with fentanyl.AnesthAnalg 1999;83:868-71.
  • 14. Harman NI, Choi KC, Afleck PJ. Analgesia, pruritis and ventilation exhibit a dose response relatıonship in parturients receiving intrathecal fentanyl during labor. AnesthAnalg 1999;89:378-83.
  • 15. Collis RE, Plaat FS, Morgan B M. Comprasion of midwife top-ups, continuous infusion and patient controlled epidural analgesia for maintaining mobility after a low-dose combined spinal epidural. Br JAnaesth 1999;82:233-6.
  • 16. Cascio M, Pygon B, Bennett C, Ramanathan S. Labour analgesia with intrathecal fentanyl decreases maternal stress. Can JAnesth 1997;44:605-609.
  • 17. Tsen LC, Thue B, Data S, Segal S. Is combined-spinal epidural analgesia associated with more rapid cervical dilatation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999;91:920-5.
  • 18. Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Eng J Med 1997;337:1715-9.
  • 19. Stoddart AP, Nicholson KEA, Popham PA. Low dose bupivacaine/fentanyl epidural infusions labour and mode of delivery.Anesthesia 1994;49:1087-90.
  • 20. Olofsson C H, Ekblom G, Ekman-Ordeberg G, Irested L. Obstetric outcome following epidural analgesia with bupivacaine-adrenaline 0.25% or bupivacaine 0.125% with sufentanil. A prospective randomized controlled study in 1000 parturients. Acta Anaest Scand 1998;42:284-92.
  • 21. Hughes D, Simmons SW, Brown J, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2003;(4):CD003401.
  • 22. Bren TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in ambulatory patient,AnaesthAnalg 1993;77:919-924.
  • 23. Kuczkowski KM. Ambulation with combined spinalepidural labor analgesia: the technique. Acta Anaesthesiol Belg. 2004;55:29-34.
  • 24. Stacey RG, Watt S, Kadim MY, Morgan BM. Single space combined spinal-extradural technique for analgesia for labour. Br JAnaesth 1993;71:499-502.
  • 25. Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural analgesia, Technique, management, and outcome of 300 mothers. Int J ObstAnest 1994;3:75-81.
  • 26. Sheila EC, Julie Y, Edward TR, Tracey MV. Walking with labor epidural analgesia. Anesthesiology 2000;92:387-92.
  • 27. Capogna G, Camorci M. Epidural analgesia for childbirth: effects of newer techniques on neonatal outcome. Paediatr Drugs 2004;6:375-86.
  • 28. Uysalel A. Epidural analjezinin doğumun ilerlemesi veyeni doğan üzerine etkileri. TARK 2001özet kitabı 297-302.
  • 29. Clarke VT, Similey RM, Finster M. Uterin hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia? (letter).Anesthesiology 1994; 81:1083-1087.
  • 30. Sia AT, Camann WR, Ocampo CE, Goy RW, Tan HM, Rajammal S. Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour. Can JAnaesth 2004;51:581-5.
There are 30 citations in total.

Details

Other ID JA42AC73CU
Journal Section Research Article
Authors

Mehmet Çelik This is me

Lütfiye Pirbudak Çöçelli This is me

Ebru Dikensoy This is me

Özcan Balat This is me

Ünsal Öner This is me

Saime Şahınöz This is me

Publication Date April 1, 2007
Published in Issue Year 2007 Volume: 8 Issue: 1

Cite

EndNote Çelik M, Pirbudak Çöçelli L, Dikensoy E, Balat Ö, Öner Ü, Şahınöz S (April 1, 2007) Comparison of Clinical Efficacies of Combined Spinal -Epidural versus Epidural Analgesia Techniques Performed with the Continuous Patient Controlled Infusion Method in Labor Analgesia. Meandros Medical And Dental Journal 8 1 27–33.