Epidural anestezi doğumun evrelerini ve yenidoğan bebeği nasıl etkiler? 90 olgunun prospektif analizi.

Yıl 2022, Cilt: 19 Sayı: 3, 1418 - 1423, 30.09.2022

Yunus Çavuş Uğur Değer Veysel Toprak Meryem Özge Çakır Nemli

https://doi.org/10.38136/jgon.1062380

Öz

Amaç: Epidural anestezi (EA), ağrının azaltılmasında ve doğum sırasında tamamen ortadan kaldırılmasında en etkili yöntemdir. Bu çalışmanın amacı, EA'nın doğum sürecinin birinci ve ikinci kısmı üzerindeki etkisini ve EA'nın yenidoğan ve anne üzerindeki etkisini belirlemektir.
Yöntem : Hastanemizde toplam 153 primipar gebe seçildi. Epidural doğum analjezisini kabul edip etmemesine göre çalışma grubu 90 primipar gebe, kontrol grubun 63 primipar olmak üzere iki ayrı gruptan oluşturuldu. Her iki grup da vajinal doğum yaptı. Anestezik olarak 18 G kateterlerle Bupivakain (%0,25 veya %0,125) +2µg/ml fentanil kullanıldı. Uygulama seviyesi omurganın L2-L3 seviyesi idi. Dilatasyon ve efesman düzeyi, doğumun birinci, ikinci ve üçüncü evrelerinin süresi, primiparların anormal durumu ve komplikasyonları değerlendirildi.
Bulgular: Analiz sonucunda çalışma grubundaki gebelerin bebeklerinin doğum ağırlıkları kontrol grubuna göre anlamlı olarak yüksek bulundu (p<0.05). Analjeziden 30 dakika sonra çalışma grubunun NRS skoru kontrol grubundan daha düşüktü (P<0.001). Çalışma grubundaki bebek Apgar skorları kontrol grubuna göre anlamlı derecede yüksekti (p<0,001). Çalışma grubunda evre I için ortalama süre 2.27 ± 1.26 saatti ve kontrol grubuna göre anlamlı derecede düşüktü (p <0.001). Tam dilatasyondan doğuma kadar geçen süre (evre II) çalışma grubunda kontrol grubuna göre anlamlı olarak daha uzun bulundu (p<0,001). Çalışma grubu ve kontrol grubu arasında doğum sonu kanama, baş dönmesi ve kusma miktarında komplikasyonlar açısından anlamlı fark yoktu. Çalışma grubunda idrar retansiyonu insidansı kontrol grubuna göre daha yüksekti (p<0,05).
Sonuç: Bu çalışmada epidural anestezi uygulamasının doğum süresini kısalttığı, güvenli olduğu, hastayı rahat ettirdiği ve yenidoğan üzerinde herhangi bir olumsuz etkisi olmadığı görülmektedir.

Anahtar Kelimeler

Epidural anestezi, vajinal doğum, neonatal sonuçlar

How can epidural anestesia affect the delivery stages and a newborn infant ? The prospective analysis of 90 cases

Öz

Objective: Epidural anaesthesia (EA) is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process and the effect of EA on the newborn and mother.
Method : A total of 153 primiparas in our hospital were selected and divided into two groups according to whether they accepted epidural labor analgesia, including 90 cases in the study group and 63 cases in the control group. Both groups had vaginal delivery. As anaesthetic, Bupivacain (0,25% or 0, 125%) +2µg/ml fentanyl was used by the 18 G catheters. Level of application was L2-L3 part of spine. Dilatation and efesman level, duration of the first, second and third stages of labor, the abnormal situation and complications of primiparas were evaluated.
Result: As a result of the analysis the birth weight of the babies of the pregnant women in the the study group was significantly higher than the control group (p <0.05). The study group’s NRS score was lower than that of the control group at 30 min after analgesia (P<0.001). The Apgar scores of the babies in the study group was significantly higher than the control group (p <0.001). The mean time for stage I in the study group was 2.27 ± 1.26 hours and was significantly lower than the control group (p <0.001). The time from full dilatation to delivery (stage II) was found to be significantly longer in the study group than in the control group (p<0.001). In terms of complications, there was no significant difference in the amount of postpartum haemorrhage, dizziness and vomiting in the study group and control group. The incidence of urinary retention in the study group is higher than that in the control group (p <0,05).
Conclusion: In this study, the application of epidural anaesthesia seems to shorten the duration of delivery, be safe, make the patient comfortable, and has no any adverse effects on newborns.

Anahtar Kelimeler

Epidural anesthesia, vaginal delivery, neonatal outcomes

Kaynakça

• McDonald JS, and Noback CR. Obstetric pain. In Handbook of Pain Management (pp. 147-161). Churchill Livingstone, 2003.
• Van der Gucht N, and Lewis K. Women׳ s experiences of coping with pain during childbirth: a critical review of qualitative research. Midwifery, 2015;31(3), 349-358.
• Barash P, Cullen BF, Stoelting RK, Cahalan M, Stock MC, and Ortega R. Handbook of clinical anesthesia. Lippincott Williams & Wilkins, 2013.
• Beilin Y. Advances in Labor Analgesia. Mt Sinai J Med, 2002;69(1-2):38-44.
• Collis RE, Davies DWL, Aveling W. Randomised comprasion of combined spinal-epidural and standart epidural analgesia in labour. Lancet, 1995;345:1413-16.
• Smiley RM, Stephenson L. Patient –controlled epidural analgesia for labor. Int Anesthesiology Clin 2007;Winter ;45(1) :83-98.
• Morgan GE, Mikhail MS, and Murray MJ. Clinical anesthesiology (No. RD 81. M67 2002).
• Capogna G, and Camorcia M. Epidural analgesia for childbirth. Pediatric Drugs, 2004;6(6), 375-386.
• Kranke P, Annecke T, Bremerich DH, Hanß R, Kaufner L, Klapp C, and Volk T. Anesthesia in obstetrics: Tried and trusted methods, current standards and new challenges. Der Anaesthesist, 2016;65(1), 3-21.
• Wasson C, Kelly A, Ninan D, and Tran Q. Epidural, Caudal, Spinal, Combined Spinal/Epidural. In Absolute Obstetric Anesthesia Review (pp. 53-59). Springer, Cham. 2019.
• Jouppila R. Maternal and fetal effects of epidural analgesia during labour. Zbl Gynekol, 1985,107: 521–31.
• Cooper, D. W., Carpenter, M., Mowbray, P., Desira, W. R., Ryall, D. M., & Kokri, M. S. (2002). Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology, 2002;97(6), 1582-1590.
• Sumikura H, Niwa H, Sato M, Nakamoto T, Asai T, and Hagihira S. Rethinking general anesthesia for cesarean section. Journal of Anesthesia, 2016;30(2), 268-273.
• Chen XN, Yang SH, Lin HR, Chen NN, Su CL and Huang W. Acupoint injection of ropivacaine for labor analgesia and its effect on maternal cor- tisol levels. J South Med Univ 2018; 38: 138- 140.
• Xu DX. Clinical analysis of labor analgesia for vaginal trial delivery of pregnant women after cesarean section. Chin Matern Child Health Care 2020; 35: 63-65.
• Wu SW, Shi QY, Chen Y, Wang X and Zhang WY. The effect of oxytocin during labor on the time limit of labor and maternal and fetal outcomes of pregnant women with vaginal delivery after cesarean section. Chin J Obstet Gynecol 2020; 55: 194-197.
• Hawkins JL. Epidural analgesia for labor and delivery. New England Journal of Medicine, 2010;362(16), 1503-1510.
• Silva M, and Halpern SH. (2010). Epidural analgesia for labor: Current techniques. Local Reg Anesth. 2010;3, 143–153.
• Khaneshi R, Rasooli S, Moslemi F, and Fakour S. Comparison of continuous epidural infusion of bupivacaine and fentanyl versus patient controlled analgesia techniques for labor analgesia: a randomized controlled trial (RCT). J Reprod Infertil, 2020;21(1), 42-48.
• Liu SS, Allen HW, and Olsson GL. Patient-controlled Epidural Analgesia with Bupivacaine and Fentanyl on Hospital Wards Prospective Experience with 1,030 Surgical Patients. Anesthesiology, 1998;88(3), 688-695.
• Liang XQ and Li DR. The effect of AIDET communication mode combined with epidural anesthesia analgesia on maternal stress and pregnancy outcome. Med Clin Res 2019; 36: 1588-1590.
• Wang LL, Peng GQ and Zhao CF. The effect of combined spinal-epidural anesthesia and epi- dural anesthesia on the levels of corticotropin, cortisol and C-reactive protein in parturient women in painless delivery. Chin Matern Child Health Care 2020; 24: 4884-4886.
• Cheek TG, Gutsche BB. Epidural analgesia for labor and vaginal delivery. Clin Obstet Gynecol 1987; 30(3): 515–29.
• H. Tanaka et al. /Taiwanese Journal of Obstetrics & Gynecology 57 (2018) 190e193.
• Ojo OA, Mehdiratta JE, Gamez BH, Hunting J and Habib AS. Comparison of programmed intermittent epidural boluses with continuous epidural infusion for the maintenance of labor analgesia: a randomized, controlled, double-blind study. Anesth Analg 2019; 130: 1.
• Lacassie H.J, Habib A.S, Lacassie H.P, Columb M.O: Motor blocking minimum local anesthetic concentrations of bupivacaine, levobupivacaine, and ropivacaine in labor, Reg Anesth Pain Med 2007Aug;(32)4:323-9.
• Brownridge P. The nature and consequences of childbirth pain. European Journal of Obstetrics & Gynecology and Reproductive Biology, 1995;59, 9-15.
• Ahmet G, and Ebru C. Epidural analgesia for labor pain: what has changed in the last 1 year? Literature review and clinical results our experience in labor analgesia. Journal of Clinical and Analytical Medicine, 2019;1-7.
• Anim‐Somuah M, Smyth RM, Cyna AM, and Cuthbert A. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev., 2018;5, CD000331.