DO/UMDA NÖRAKS

Bu çalışmada epidural ve kombine spinal epidural (KSE) tekniklerini içeren standart nöraksiyel doğum analjezisi ile yeni birnöraksiyel yaklaşım olan dural ponksiyonlu epidural (DPE) tekniğinin karşılaştırılması sunulmuştur. Nöraksiyel analjeziyönetimine kısaca değindikten sonra standart nöroaksiyel teknikler ile yeni yaklaşımların avantaj ve dezavantajlarını özetleyerekkarşılaştırdık. Son yıllardaki kanıtlara göre DPE, daha uygun risk yarar oranı sunmaktadır. Fakat hangi nöraksiyel tekniğinseçileceği obstetrik risk faktörleri, hastanın tercihi, doğumun gelişim süreci, hastanedeki imkanlar da göz önünde bulundurularak kişiye özel planlanmalıdır.

NEURAXIAL ANALGESIA FOR LABOR: STANDARD TECHNIQUES VERSUS NOVEL APPROACH

Standard neuraxial labor analgesia techniques that include epidural and combined spinal epidural (CSE) and comparison ofthese standard techniques with novel neuraxial approach which is dural puncture epidural (DPE) are presented. After brief overviewof neuraxial analgesia management, advantages and disadvantages of standard neuraxial techniques versus novel approach aresummarized. Based on the latest evidences, DPE appears to offer favorable risk benefit ratio for labor analgesia. However, choiceof a specific neuraxial technique should be individualized based on the anesthetic and obstetric risk factors, patient preferences,progress of labor and resources of the facility.

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1. Camann W, Alexander KJ. Easy Labor. New York: Ballatine's Books 2006 (Çeviri: Gunaydin B. Kolay Do¤um Ankara: _____lke Yay>nevi 2008).
2. Kuczkowski KM, Drobnik L. International Textbook of Obstetric Anaesthesia and Perinatal Medicine. In: Gunaydin B. Obstetric pain and its management in the perinatal period: What do we need to know? Warsaw: Medmedia 2010; 34-39.
3. Wong CA. Advances in laboranalgesia. Int J Women'sHealth 2009;1: 139-154.
4. Chestnut D, Wong C, Tsen L, Kee WDN, Beilin Y, Mhyre J. 2014. Chestnut's Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia: Saunders.
5. ACOG Committee on Obstetric Practice. Opinion No: 269. Obstet Gynecol 2002; 93: 369-370.
6. http:// asahq/publicationsAndservices/standards/47.pdf; reaffirmed in 2007; Date last accessed. June 8, 2008.
7. Practice Guidelines for Obstetric Anesthesia. An updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society of Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124: 270-300.
8. Wong CA, Scavone BM, Peaceman AM et al. The risk of cesarean delivery with given early versus late in labor. New Eng J Med 2005; 352: 655-665.
9. Whitty R, Goldszmidt E, Parkes RK, Carvalho JC. Determination of the ED95 for intrathecal plain bupivacaine combined with fentanyl in active labor. Int J Obstet Anesth. 2007; 16: 341-345.
10. Sezer OA, Gunaydin B. Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal epidural analgesia. Int J Obstet Anesth 2007; 16: 226-230.
11. Suzuki N, Koganemaru M, Onizuka S, Takasaki M. Dural puncture with a 26-Gauge spinal needle affects spread of epidural anesthesia. Anesth Analg 1996; 82: 1040-1042.
12. Thomas JA, Pan PH, Harris LC, Owen MD, D'Angelo R. Dural puncture with 27 Gauge Whitacre spinal needle as part of a CSE technique does not improve labor epidural catheter function. Anesthesiology 2005; 103: 1046-1051.
13. Cappiello E, O'Rourke N, Segal S, Tsen LC. A randomized trial of dural puncture epidural (DPE) technique compared with standard epidural technique for labor analgesia. Anesth Analg 2008; 107: 1646-1651.
14. Chau A, Bibbo C, Huang CC et al. Dural puncture epidural technique (DPE) improves labor analgesia quality with fewer side effects compared with epidural and CSE techniques: A randomized clinical trial. Anesth Analg 2017; 124: 560-569.