Tayfun SÜĞÜR, Esra KIZILATEŞ, Ali KIZILATEŞ, Kerem İNANOĞLU, Bilge KARSLI

Doğum analjezisi: Epidural hasta kontrollü analjezi ile intravenöz hasta kontrollü analjezinin karşılaştırılması

Amaç: Çalışmamızda doğum analjezisi yöntemlerinden, hasta kontrollü epidural analjezi (HKEA) ile hasta kontrollü intravenöz remifentanil analjezisi (HKİVA), hasta memnuniyeti, vizüel analog skala (VAS), anne ve yenidoğan yan etkileri açısından karşılaştırıldı. Gereç ve Yöntem: Tek fetüse sahip, doğum analjezisi isteyen 37 gebe HKİVA (Grup 2) ve HKEA (Grup 1) gruplarına ayrıldı. Grup 1 için hazırlanan 100 mL epidural mayi içinde 1.25 mg/mL bupivakain, 2 mcg/mL fentanil bulunmaktaydı. Başlangıç dozu, 5 mL’lik bölünmüş dozlar halinde 15 mL uygulandı. Devamında 5 mL/saat bazal infüzyon, 5 mL hasta kontrollü bolus ve 20 dk kilit olarak ayarlandı. Grup 2 için hazırlanan solüsyona, 100 mL mayi içine 2 mg remifentanil konuldu. 20 mcg/h infüzyon dozu, 0.05 mcg/kg hasta kontrollü bolus ve 5 dk kilit olarak ayarlandı. Gebelerin, doğum eylemi bitene kadar VAS, maternal kalp hızı, kan basıncı, oksijen satürasyonu, bulantı, kusma, kaşıntı, sedasyon, fetal kalp hızı ve doğum eylemi sonunda yenidoğan Apgar skoru ve anne memnuniyetleri kaydedildi. Bulgular: İki grubun da yeterli düzeyde analjezi sağlayabildiği görülmüştür. Ancak VAS değerleri grup HKİVA’da daha yüksek bulunmuştur. Anne memnuniyetleri ve yenidoğan Apgar skorları benzerdi. Her iki grupta da oksijen desteği gerektiren satürasyon düşüklüğü saptanmamasına rağmen, oksijen satürasyonları Grup 2’de daha düşük seyretti. Yan etki ve hasta memnuniyetleri her iki grupta da benzer bulundu. Sonuç: Remifentanil ile intravenöz HKA’da, anne memnuniyeti yeterli görülse de, HKEA ile karşılaştırıldığında 2. saatten sonraki VAS skorları daha yüksekti. Biz HKEA’nın doğum analjezisinde altın standart olduğunu düşünmekle birlikte, epidural kateter uygulamasının kontrendike olduğu veya gebenin epidural girişimi istemediği durumlarda, HKİVA’nın epidural analjeziye iyi bir alternatif olduğunu düşünmekteyiz.

Labor analgesia: Comparison of epidural patient-controlled analgesia and intravenous patient-controlled analgesia

Objectives: In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) were compared for VAS, and also their side effects on mother and newborn. Methods: In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and PCEA (Group 1). Bupivacaine 1.25 mg/ml and fentanyl 2 mcg/ml in 100 ml epidural solution were prepared for Group 1. The infusion dose was 15 ml, 5 ml divided doses. We set 5 ml/h basal infusion, 5 ml patient-controlled bolus and 20 min lock time. We prepared 2 mg remifentanil in 100 ml intravenous solution for Group 2. We set 20 mcg/h infusion, 0.05mcg/ kg patient-controlled bolus and five min lock time. VAS, maternal-fetal heart rate, blood pressure, oxygen saturation, nauseavomiting and sedation were recorded during labor. We recorded Apgar scores and maternal satisfaction at the end of labor. Results: The findings showed that both groups could provide adequate analgesia. However, VAS scores were higher in Group PCIVA. The mother satisfaction and newborn’s Apgar scores were similar. In both groups, desaturation, which is requiring oxygen support, was not determined. The oxygen saturations were lower in Group 2. The side effects and patient satisfaction were similar in both groups. Conclusion: Although PCIVA was found to be satisfactory concerning maternal satisfaction, VAS after 2nd hour were higher compared to PCEA. PCEA is the gold standard in labor analgesia. However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated or where the patient does not want an epidural.

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