Effects Of Combined Spinal-epidural Analgesia Research Articles

The effects of combined spinal-epidural analgesia and epidural anesthesia on maternal intrapartum temperature: a randomized controlled trial

BackgroundLabor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature.MethodsFour hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded.ResultsMaternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group.ConclusionOur findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia.Trial registrationChiCTR1900026606. Registered on 16/10/2019.

Місце епідуральної аналгезії з проколом твердої мозкової оболонки як сучасного методу знеболювання пологів

Пологи — фізіологічний процес, що супроводжується вираженим больовим синдромом. У патологічний процес можуть бути залучені фізіологічні та психологічні чинники. Підвищення концентрації катехоламінів може сприяти зниженню матково-плацентарної перфузії. Біль під час пологів може призвести до гіпервентиляції матері, що, зі свого боку, може вплинути на кислотно-основний стан плода та стан новонародженого. Тривалий больовий синдром може призвести до розвитку тяжких психологічних розладів із порушенням зв’язку між матір’ю і новонародженим. Гострий біль під час пологів може трансформуватися в хронічний у післяпологовому періоді. Найбільш ефективними є нейроаксіальні методи знеболювання пологів: епідуральна аналгезія (ЕА), комбінована спінально-епідуральна аналгезія (КСЕА) та їх модифікації. Класична ЕА справляє мінімальні небажані та побічні ефекти, але може бути пов’язана з високою частотою недостатнього рівня знеболювання. Частота неадекватних епідуральних блокад доходить до 23 %. КСЕА на відміну від ЕА має вищу якість сенсорної блокади, але вона пов’язана з більшою частотою побічних ефектів, таких як гіпотензія, виражений моторний блок, порушення частоти серцевих скорочень плода. З 2005 року в практику акушерських анестезіологів почала впроваджуватись епідуральна аналгезія з проколом твердої мозкової оболонки (Dural puncture epidural — DPE) як метод, що покликаний покращити якість класичної ЕА з мінімальними небажаними ефектами КСЕА. Дані наявних досліджень показують, що DPE потенційно покращує якість аналгезії (швидше настає знеболювання, краще покриття сакральних сегментів, нижча частота неадекватних блокад) порівняно з ЕА та менше викликає гіпотензію, порушення ритму частоти серцевих скорочень плода порівняно з КСЕА. Але в досягненні даних ефектів важливий діаметр спінальної голки. Подальші дослідження можуть бути націлені на визначення тривалості пологів, варіанта розродження та можливого впливу DPE на вегетативну регуляцію пологів та більш широке вивчення впливу данного методу на плід і новонародженого.

Our New Choice in Labour Analgesia, Combined Spinal-Epidural Analgesia: Our Short Term Results

Objective: Nowadays, the painless childbirth preference of expectant mothers is gradually increasing. The most important and first objective in labor analgesia should be the safety of mother and baby. Our objective in this study is to compare the effects of combined spinal-epidural analgesia (CSE) and epidural analgesia on analgesia quality and labor in labour analgesia.Methods: Our study was performed prospectively on 40 primigravid pregnant women who requested painless childbirth and were included in the ASAI-II group, between September 1, 2018, and November 30, 2018. Pregnant women who had single fetus at 36-42 weeks, have vertex presentation, no contraindications for regional analgesia, have active contractions and with 3-4 cm cervical opening were randomly divided into two groups in the study. Combined Spino Epidural group (= Group CSE, n = 20), Epidural analgesia group (= Group EPI, n = 20) was determined as the groups. To the pregnant women in the Group CSE, Intrathecal dose in a manner that 2.5 mg hyperbaric bupivacaine + 12.5 µg fentanyl total volume of 1 ml was injected. To the pregnant women in the Group EPI, 20 G epidural catheter was placed with the method used in the first group and fixed to the skin. Epidural analgesia solutions (20 mg bupivacaine + 50 µg fentanyl +15 cc saline) were prepared in 20 cc injectors containing 0.1% bupivacaine + 2.5 µg/ml fentanyl for use in both groups. When the VAS values became 4, these prepared solutions were planned to be given as 10 ml intermittent bolus from these epidural catheters.Results: The mean values of maternal age, weight, and height, and infant height have not shown any difference according to the groups (p> 0.05). The first VAS median value was obtained as 5 in both groups. However, the VAS values were accumulated in the higher values in the combined spinal-epidural group (p = 0.031). Although the second VRS and VAS median values were lower in the pure epidural, the outlet VRS and VAS values have been obtained lower in the combined spinal-epidural group. Conclusion: For normal spontaneous vaginal delivery, every mother should be offered labour analgesia options such as CSE analgesia and epidural analgesia. CSE analgesia may be a good alternative to epidural analgesia because of its advantages such as the onset of fast analgesia, shortening the first stage of labour and increasing the comfort of the mother in the outlet.

Influence of combined spinal-epidural analgesia on serum levels of IL-1β,IL-10 and T lymphocyte subsets in maternity

Objective To investigate the effect of combined spinal-epidural analgesia(CSEA) on immunological function and Th1/Th2 balance by observing the levels of serum T-lymphocyte subsets,IL-1β and IL-10 during labor in maternity.Methods Fifty healthy primipara expecting spontaneous labor were randomly divided into two groups(n=25).CSEA was performed with 20 μg fentanyl for lumbar analgesia and with complex of ropivacaine(0.1%) and fentanyl(2 μg/ml) for epidural analgesia in group Ⅰ,and no labor analgesia was given in group Ⅱ.Serum cortisol,IL-1β,IL-10 and T lymphocyte subsets was detected at cervical dilation of 2 cm-3 cm (T1),fetal disengagement (T2) and 24 h after childbirth (T3).Labor progress,VAS and neonatal Apgar score were recorded.Results The active phase of the first labor stage significantly shortened in group Ⅰ compared to that in group Ⅱ (P＜0.05),without difference in neonatal Apgar score between two groups.Along with labor progress,the level of serum IL-1β markedly increased in two groups,and the levels of cortisol,IL-1β and IL-10 were obviously decreased at T2 in group Ⅰ compared to those in group Ⅱ(P＜0.05).The levels of serum CD3+,CD4+,and CD4+/CD8+ decreased in both groups,with significant reduction at T3 (P＜0.05) and more significant in group Ⅱ than in group Ⅰ (P＜0.05).Conclusion CSEA shortens the active delivery phase in the first stage of labor and alleviates pain stress-induced inhibition on immune function and may benefit the balance of Th1/Th2 in maternity. Key words: Combined spinal-epidural analgesia; Labor; T lymphocyte subsets; Interleukin-1β; Interleukin-10

A randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation

Background Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia. Methods Parturients with singleton breech presentation (n = 96) were randomized to receive CSE analgesia with bupivacaine 2.5 mg and fentanyl 15 μg (CSE group) or intravenous fentanyl 50 μg (SYS group) before ECV attempt. The primary outcome was ECV success. Results The success rate of ECV was 47% with CSE and 31% in the SYS group ( P = 0.14). Subsequent vaginal delivery was 36% for CSE and 25% for SYS ( P = 0.27). Median [IQR] visual analog pain scores (0-100 mm scale) were lower with CSE (3 [0-12]) compared to SYS analgesia (36 [16 to 54]) ( P < 0.005) and patient satisfaction (0-10 scale) was higher (CSE 10 [9 to 10] versus SYS 7 [4 to 9]) ( P < 0.005). There were no differences in fetal heart rate patterns, but median time to return to fetal heart rate reactivity after analgesia was shorter with CSE (13 [IQR 9-21] min) compared to the SYS group (39 [IQR 23-51] min) ( P = 0.02). Conclusions There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.

Influence de l’anesthésie péridurale sur la durée et les modalités de l’accouchement

Objective: To determine the effect of epidural analgesia (EA) on the duration of labour and the mode of delivery. Data sources: A Medline computerised literature research was conducted from 1989 to 2000 including all the prospective studies comparing EA and systemic analgesia during labour. Data synthesis: EA prolongs the first and second stages of labour and increases the rate of instrumental delivery, without neonatal side effects. EA is not responsible for dystocia and caesarean section rate is not increased by this mode of analgesia. The effect of combined spinal-epidural analgesia is comparable to the one of EA on the length of labour and the mode of delivery. Ropivacaine does not appear to be different from bupivacaine in that setting. The benefit of ambulation remains controversial since it does not reduce the incidence of instrumental delivery, compared to conventional EA with similarly diluted local anaesthetic solutions. Conclusions: Pain relief provided by EA combined to modification of obstetric management (amniotomy, oxytocin) does not impair the rate of caesarean section and dystocia.