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

Yıl 2019, , 1303 - 1316, 15.04.2019

Gerçek Aydın Mehpare Tüfekçi Mehmet Bülbül , Ahmet Yılmaz Kemal Özerkan

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

Analgesia, Epidural analgesia, Labor, Pain, Paracetamol

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