Use of the narcotic analgesic fentanyl to correct violations of the autonomic regulation of childbirth

Abstract

Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.