Mehmet ÖZALEVLİ, Okan BALCIOĞLU, Özge DEMİR, Selim DEMİR, Cüneyt EVRÜKE, Hasan AKMAN

Primipar olgularda değişik servikal açıklıklarda uygulanan epidural analjezinin travay süresi ve doğum eylemi üzerine etkileri

Son yıllarda travayın farklı dönemlerinde uygulanan epidural analjezinin doğum eyleminin süresini ve şeklini değiştirebileceği konusunda farklı görüşler bildirilmiştir. Çalışmamızda primipar anne adaylarında değişik servikal açıklıklarda uygulanan epidural analjezinin travay süresi, doğum şekli ve Sezaryen olasılığı üzerine etkilerinin araştırılması amaçlandı. Etik komite izni alınarak vajinal doğum planlanan 136 gebe rasgele seçimle 2 ana gruba ayrıldı. Her ana grup kendi içinde servikal açıklığı < 4 cm olanlar 1a ve IIla, 4-5 cm olanlar 1b ve IIb ve 5 cm> olanlar 1c ve IIc olmak üzere 3'er alt gruba ayrıldı. Grup l'e analjezi sağlamak amacıyla epidural katater yerleştirildi. Grup II'ye ise travay süresince herhangi bir analjezik ajan verilmedi. Grup 1'e epidural yoldan 12.5 mg bupivakain +50 $mu$g fentanil yükleme dozunun ardından 10 mL'sinde 12,5 mg bupivakain ve 25 $mu$g fentanil bulunan solüsyondan bazal infüzyon hızı 10 mL $saat^-1$, bolus dozu 5 mL ve kilitli kalma süresi 30 dakika olacak şekilde hasta kontrollü epidural analjezi (HKEA) başlandı. Tüm olguların demografik verileri, gebelik sayısı, servikal açıklık, latent ve aktif faz süreleri ve total travay süreleri kaydedildi. Ek olarak olguların sistolik-diyastolik kan basıncı (SKB-DKB), kalp atım hızı (KAH), periferik oksijen satürasyonu (SpO2) ve fetal kalp atım hızları (FKAH) izlenerek kaydedildi. Epidural analjezi uygulanan tüm alt gruplarında, latent faz sürelerinin iki grup arasında benzer olduğu, aktif fazın l. evresinin ise istatistiksel olarak anlamlı bir şekilde kısa olduğu saptandı (p

Anahtar Kelimeler:

Bupivakain, Doğum evresi, birinci, Fentanil, Analjezi, epidural

The effects of the epidural analgesia on the progress of the labor and labor outcome at different degrees of cervical dilatation

Recently, different results have been reported that epidural analgesia prolongs labor, increases instrumental vaginal delivery and operative delivery. The purpose of the present study was to determine the effects of the epidural analgesia on the progress of labor and labor outcome at different degrees of cervical dilatation. After approval by the ethical committee, a total of 136 patients scheduled for vaginal delivery were divided into 2 groups. Each group divided into 3 subgroups according to the degree of cervical dilatation. In these subgroups; the degree of cervical dilatation was <4 cm in group la and IIa 4-5 cm in group Ib and lIb and >5 cm in group Ic and lIc. Epidural catheters were placed for analgesia in group I. Group II was not given any analgesic therapy during labor. Group I parturient received an epidural injection of 12.5 mg (0.125 %) bupivacaine + 50 $mu$g fentanyl. Then they received 0.125 % bupivacaine with 2.5 $mu$g $ml^-1$ fentanyl via patient controlled analgesia (PCA). Patient controlled epidural analgesia (PCEA) background infusion was launched at a rate of 10 mL $hour^-1$ Patients receiving PCEA were allowed to administer themselves a bolus dose of 5 mL every 30 min as needed. Demographic data, number of pregnancy, degree of cervical dilatation, latent and active phases of the labor (in the first and in the second stage), and duration of total stage of the labor was recorded. Additionally, systolic - diastolic blood pressure (SBP-DBP), fetal (FHR) and maternal (HR) heart rates and peripheral oxygen saturation (SpO2) were also assessed. However, duration of the first and total stage of the labor was found significantly shorter in epidural subgroups duration of latent phase of the labor was similar between two groups, (p < 0.05). Although duration of the second stage of the labor was found shorter in all epidural subgroups, it was statistically not significant. It was found that the incidence of instrumental vaginal delivery and frequency of Caesarean section was not significant between two groups. In conclusion; epidural analgesia applied at different cervical dilatations, shortened the duration of the first stage and total duration of the labor, but it did not change the duration of the second stage of the labor. Epidural analgesia did not cause an increase in the incidence of instrumental vaginal delivery and the frequency of Caesarean section.

Keywords:

Bupivacaine, Labor Stage, First, Fentanyl, Analgesia, Epidural,

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