Epidural yöntem ile yapılan doğum analjezisinde bupivakain ve levobupivakainin karşılaştırılması

Amaç: Kadınların hayatları boyunca yaşayabilecekleri en şiddetli ağrılardan biri doğum ağrısıdır. Doğum ağrılarını dindirmek için günümüzde birçok medikal ve psikolojik yöntem kullanılmaktadır. Epidural analjezi yöntemi günümüzde obstetrik analjezi için mevcut en iyi yöntemdir. Gereç ve Yöntem: Çalışmamız, Sağlık Bakanlığı İstanbul Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniğine başvuran, vajinal doğum planlanan, doğum eylemi başlamış ve servikal dilatasyonu 3-6 cm olan ASA-I, 60 gebede yapıldı. Hasta kontrollü epidural analjezi yöntemi uygulanarak düşük dozda fentanil ile kombine edilen bupivakain 30 gebeye uygulandı (Grup B). Aynı yöntemle uygulanan düşük dozda fentanil ile kombine edilen levobupivakain 30 gebeye uygulandı (Grup L). Her iki grup arasında anne ve fetüs üzerine hemodinamik parametreler, doğum eylemi seyri, ağrı şiddeti ve yeni doğan üzerine etkileri ve anne memnuniyeti karşılaştırıldı. Bulgular: Çalışmamızda gruplar arasında motor blok gelişimi açısından fark saptanmaz iken duyusal blok 15., 30., 45. ve 90. dakikalarda grup L’de daha az gözlendi. Ayrıca 5. dk ağrı skoru (VAS) grup L’de daha düşük bulundu. Diğer zamanlardaki VAS değerleri gruplar arasında benzerdi. Sonuç: Sonuç olarak, %0.125 bupivakain veya %0.125 levobupivakain kullanılarak yapılan hasta kontrollü epidural analjezi yöntemiyle benzer yan etki sıklığı ile yeterli doğum analjezisi sağlanmaktadır. Her iki lokal anestezik ilacında doğum analjezisinde güvenli olarak kullanılabileceği sonucuna varıldı.

Comparison of bupivacaine and levobupivacaine with epidural technique for labor analgesia

Objectives: The labor pain is one of the most severe pains that a woman could ever be suffered. Today, many medical and psychological methods are used in an effort to reduce labor pain.Epidural analgesia is the best current method used for the purposes of obstetric analgesia. Methods: The study was carried out on 60 ASA-I pregnant women whose 3 to 6 cm of cervical dilatation, treated in Health Ministry Istanbul Education and Research Hospital, Gynecology and Obstetrics Clinic, within vaginal labor process. With use of patient controlled epidural analgesia method, the bupivacaine combined with low dose fentanyl were administered to 30 pregnant women (Group B). Levobupivacaine, combined with low dose fentanyl applied with the same method was administered to another 30 pregnant women (Group L). Between the two groups, the hemodynamic parameters on the mother and fetus, the course of the labor process, severity of pain, its influences on newborn and mother satisfaction were compared. Results: In our study, there was no difference as to motor block development between groups, but the sensory block was monitored less in group L at the minutes 15, 30, 45 and 90. Furthermore, the 5 minutes pain score was found lower in group L. The VAS values at the other times were similar between groups. Conclusion: In conclusion, with the usage of 0.125% bupivacaine or 0.125% levobupivacaine, sufficient labor analgesia is achieved with patient controlled epidural analgesia method at the same side effect frequency. Consequently, both local analgesic medicines are seemed to be safely used in labor analgesia.

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