ОБОСНОВАНИЕ ЦЕЛЕСООБРАЗНОСТИ ПАРАВЕРТЕБРАЛЬНОЙ БЛОКАДЫ ДЛЯ АНАЛЬГЕЗИИ САМОПРОИЗВОЛЬНЫХ РОДОВ

Abstract

The article presents the comparative assessment of efficiency and safety of neuraxial pain relief in labor. Subjects and methods . Four groups of 40 women in each group participated in the study: In Group 1, epidural analgesia was used for pain relief in labor, in Group 2, ultra-low-dose spinal analgesia was used, and paravertebral analgesia was used for pain relief in Group 3. And Control Group included 40 women with no pain relief in labor. The efficiency of analgesia in labor was monitored (scores by N.N. Rasstrigin and B.V. Shneider), as hemodynamic rates: heart rate, arterial tension, and median arterial tension (ATmed). Bromage scores were used for assessment of motor block. The changes in cervical dilatation and duration of the first and second period of the labor were assessed. All complications and negative effects of pain relief and impact of analgesia on the fetus were registered. Results. All methods of pain relief demonstrated statistically significant reduction of sensitivity to pain. Dilating pains were evaluated as 7.15 scores in Group 1; 6.88 scores in Group 2, and 7.43 in Group 3. In Control Group it made 3.87 scores (p < 0.001). During the second period of labor epidural and paravertebral analgesia was the most effective: 6.78 scores in Group 1 and 6.20 scores in Group 3 (p < 0.05). After pain relief in Groups 1, 2 and 3 there was a statistically significant reduction of specific peripheral vascular resistance, ATmed, reduction of cardiac index due to normalization of heart rate. In the groups with pain relief, the time from the development of analgesic effect until full dilation was statistically significantly shorter. The best result was achieved through paravertebral analgesia (27.5 minutes faster versus Control Group, p < 0.001). The statistically significant increase of active pushing phase was observed in Group 2, on the average for 6.1 minutes longer versus Control Group (p < 0.005). Conclusions. Neuraxial methods provide sufficient level of analgesia and are capable to manage labor abnormalities with no negative impact on the fetus. All represented methods of pain relief can be used for obstetric anesthesiology. In each specific obstetric situation, there is an option to choose the most appropriate method of pain relief.